Accuracy of ultrasound-guided lumbar vertebral level identification: a comparative study with palpation in elderly patients with spinal deformities.

Purpose: Accurate identification of lumbar vertebral levels is crucial for the success of various interventional procedures, but conventional fluoroscopic guidance exposes both patients and physician to radiation. While ultrasound has emerged as a potential radiation-free alternative, its accuracy in elderly patients with spinal deformities remains unclear.

Methods: In this single-center cross-sectional study, we compared ultrasound-guided versus palpation-guided lumbar level identification in 115 patients scheduled for lumbar surgery between July 2019 and January 2020. Patients were randomly assigned to ultrasound guidance (U group, n = 57) or conventional palpation (P group, n = 58). The primary outcome measure was accuracy of vertebral level identification, verified by intraoperative fluoroscopy.

Results: The U group demonstrated significantly higher accuracy (82.5%) compared to the P group (50.0%) (p = 0.0003, 95% CI [1.5-4.4]). Accuracy was particularly high at the L4 level (U group: 90.3%, P group: 55.9%, p = 0.0023). After adjusting for age and planned needle insertion site, ultrasound guidance maintained superior accuracy (OR = 5.5, 95% CI: 2.3-14.0, p = 0.0002).

Conclusions: Ultrasound guidance provides superior accuracy in lumbar level identification compared to conventional palpation, even in elderly patients with spinal deformities. This technique may offer a reliable, radiation-free alternative, potentially reducing radiation exposure while maintaining high accuracy.