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ESRA19-0542 3d computed tomography reconstruction to optimize central neuraxial block trajectory in patients with degenerative spine disease
  1. K Riutort and
  2. S Clendenen
  1. Mayo Clinic, Department of Anesthesiology and Perioperative Medicine, Jacksonville, USA


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).

Abstract ESRA19-0542 Figure 1
Abstract ESRA19-0542 Figure 2
Abstract ESRA19-0542 Figure 3

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.

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