Neuraxial Anesthesia and Risk of Root Damage: A 3D Ex Vivo Study.

IF 1.6 Q3 CLINICAL NEUROLOGY
NeuroSci Pub Date : 2024-12-03 DOI:10.3390/neurosci5040044
Hipólito Labandeyra, Xavier Sala-Blanch, Alberto Prats-Galino, Anna Puigdellívol-Sánchez
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Abstract

Cauda equina nerve roots may become damaged during neuraxial anesthesia, and post-puncture headache may appear in the case of cerebrospinal fluid leakage if needle tips are deformed due to bone contact when several attempts are needed. Our aim was to verify the correlation between skin-transverse process distance (st) and skin-dural sac distance (d) for calculation of optimal angles in a free visual guide and as a reference for the maximal depth to be traversed by the needle. Randomly selected ex vivo samples (n = 10) were flexed to reproduce the position of the lumbosacral spine during spinal anesthesia. Spinal needles were inserted perpendicular to the skin either blindly or following the inferred paramedian angle corresponding to ultrasound-measured (d). After computed tomography and three-dimensional reconstruction, both (st) and (d) were measured, and the Pearson correlation index was calculated. A free 3D-PDF tool was used to illustrate the potential affectation of nerve cuffs by needles located lateral to the dural sac. Correlation between (d) and (st) was 0.84-0.93 at L4L5-L3L4 intervertebral levels, and most needle tips were located within the spinal canal, but some traversed the zone where nerve cuffs emerge. In conclusion, ultrasound may determine if a perpendicular needle insertion is viable at midline. If not, the optimal paramedian angle and maximal depth may be determined by measuring (st).

轴向麻醉和根损伤的风险:一项3D离体研究。
在轴向麻醉过程中,马尾神经根可能会受到损伤,在多次尝试时,如果针尖因骨接触而变形,则可能出现脑脊液漏,穿刺后头痛。我们的目的是验证皮肤横突距离(st)和皮肤硬膜囊距离(d)之间的相关性,以便在自由视觉指南中计算最佳角度,并作为针穿过的最大深度的参考。随机选择离体样本(n = 10)进行屈曲,以重现腰骶棘在脊髓麻醉期间的位置。脊柱针垂直于皮肤,或盲目插入,或沿着超声测量值(d)对应的推断的准中轴线插入。经过计算机断层扫描和三维重建,测量(st)和(d),并计算Pearson相关指数。使用免费的3D-PDF工具来说明位于硬脑膜囊外侧的针对神经袖口的潜在影响。(d)和(st)在L4L5-L3L4椎间水平的相关性为0.84-0.93,大多数针尖位于椎管内,但有些针尖穿过神经袖口出现的区域。总之,超声可以确定在中线处垂直插入针是否可行。如果没有,则可以通过测量(st)来确定最佳的辅助角度和最大深度。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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