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Abstract
Background and aims Degenerative changes of the spinal vertebrae may make placement of central neuraxial blockade (CNB) challenging, for example, in patients with severe thoraco-lumbar scoliosis. By performing a simulated CNB using 3D virtual-reconstruction techniques, we aim to optimize needle trajectory and improve block success in scoliotic patients.
Methods We imported CT angiogram DICOM images into the Anatomage® imaging system of a patient with thoraco-lumbar scoliosis. The Anatomage® is a 3D virtualization technology that allows visualization of anatomy, virtual dissection, and pre-procedure treatment planning. Using this system, we simulated various needle trajectories in a patient with thoraco-lumbar scoliosis.
Results Figure 1A shows an initial planned midline epidural trajectory (MT) at the T10/T11 interspace. This resulted in a midline needle pass (MN) that failed to reach the epidural space as shown in figure 1B.
A second midline needle epidural trajectory (MT) is shown in figure 2A, a level lower, at the T11/T12 interspace. Again, the midline needle pass (MN) fails to approach the epidural space (figure 2B).
Finally, a right paramedian epidural trajectory (PT) at the T11/12 level shown in figure 3A demonstrates a correct paramedian needle pass (PN) toward the epidural space (figure 3B).
Conclusions 3D reconstruction of CT spine imaging may prove a useful modality to plan CNB blocks in patients with degenerative spine disease. Further study is needed to correlate the usefulness of pre-procedure planning using simulated needle trajectories with in-vivo placement of CNBs. While limited due to its availability, in the future, we see this technology as useful in the management of challenging patients.