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Influence of age, laterality, patient position, and spinal level on the interlamina space for spinal puncture
  1. Jinyoung Bae1,
  2. Sun-Kyung Park1,
  3. Seokha Yoo1,
  4. Young-Jin Lim1,2 and
  5. Jin-Tae Kim1,2
  1. 1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
  2. 2Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
  1. Correspondence to Professor Jin-Tae Kim, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea; jintae73{at}gmail.com

Abstract

Background and objectives The lumbar interlamina space height is an important determinant of successful spinal puncture. We aimed to evaluate the influence of age, laterality, patient position, and spinal level on the height of the interlamina window using ultrasonography.

Methods Ultrasonographic examination was performed in 20 adult patients aged under 40 years (group Y) and 20 patients aged over 60 years (group O). We set three primary outcomes: difference in the interlamina height of the ligamentum flavum-dura mater complex (LFD) according to (1) age, (2) laterality, and (3) position. For secondary outcomes, the degree of ultrasonography visualization (poor, intermediate, or good) and the depths from the skin to LFD and to anterior complex were also measured on right and left paramedian sagittal oblique view in both lateral and sitting positions at L3/4, L4/5, and L5/S1 levels. All variables were analyzed in association with age, laterality, patient position, and spinal level.

Results The interlamina height of LFD was higher, and the degree of visualization was better in group Y than in group O. It differed depending on laterality in paramedian sagittal oblique view images in the same patients at all spinal levels. The interlamina height of LFD was the largest at L5/S1 level in both groups. Position had little influence on the interlamina height of LFD.

Conclusions Scanning both sides and all spinal levels before selecting a puncture site for ultrasound-guided spinal anesthesia is recommended. The L5/S1 spinal level is a good option for spinal puncture in the elderly.

Trial registration number NCT03929874.

  • neuraxial blocks: spinal
  • neuraxial blocks: combined spinal/epidural
  • anatomy
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Footnotes

  • Contributors JB: conduct of study, acquisition of data, analysis and interpretation of data and manuscript preparation and revision. SKP: design of study, planning and analysis and interpretation. SY: conduct of study, acquisition of data and analysis and interpretation of data. YJM: conception and design of study, planning, analysis and interpretation of data. JTK: conception and design of study, planning, analysis and interpretation of data and manuscript preparation and revision.

  • Funding Support for this research was solely provided by institutional and departmental sources (SNU 800–20180395).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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