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Role of pre-procedural ultrasound imaging of lumbar spine in predicting the ease of performance of spinal anaesthesia

Introduction: Spinal anaesthesia is the most commonly performed technique among the anaesthetic procedures and the role of pre-procedural ultrasound (USG) in predicting the ease or difficulty in performing a lumbar puncture (LP) is uncertain. This study tests the hypothesis, that a good USG image of the intervertebral space is associated with an easy path for the passage of the spinal needle. Methods: Seventy patients, belonging to ASA I-III, scheduled to undergo elective surgeries under spinal anaesthetic technique at our institution were subjected to USG imaging of their lumbar spine L2-L5, before the procedure and the Transverse Midline(TM) views of the intervertebral spaces (IVS) were obtained. The visualised images were graded as BEST, GOOD and POOR according to the visibility of both the anterior and posterior complex, either of the two or none of them, respectively. A blinded anaesthetist was allowed to perform the lumbar puncture and the number of attempts in terms of skin puncture & needle passes were noted and DIFFICULTY was defined as more than 2 skin punctures and more than 5 needle passes. Statistical analysis was done using SPSS Version 20. Results: Most of the operators (81.43%) chose L3-L4 level as suitable intervertebral space and only 11.43% chose L2-L3 level and 7.14% chose L4-L5 by palpation. As a whole, spinal technique was easy in 81.43% and difficult in 18.57%. The blinded operators had chosen IVS with best views in 34.30%, with good views in 51.40% and with poor views in 14.30%. When the operator had chosen an IVS with best/good USG TM view, the spinal was performed with ease in 91.7% of the cases and proved difficult only in 8.3%. In cases where IVS with poor USG TM views had been chosen, spinal technique was easy only in 20% and difficulty was encountered in remaining 80% of the cases. USG TM view of IVS as a screening tool in predicting the ease of performance of spinal anaesthesia has a sensitivity of 96.49%, specificity of 76.92% positive predictive value of 94.83% and negative predictive value of 83.88%. Conclusion: Pre-procedural ultrasound imaging of lumbar spine can serve as a good screening tool for predicting the ease of performance of spinal anaesthesia. A good ultrasound view of the intervertebral space predicts an easy spinal technique.