Changes in needle maneuver space and optimal insertion site for midline neuraxial puncture with progressive age

Changes in needle maneuver space and optimal insertion site for midline neuraxial puncture with progressive age: An analysis in computed tomography scans

Hagenaars, Martin (Canisius Wilhelmina Ziekenhuis)
van den Dobbelsteen, J.J. (TU Delft Medical Instruments & Bio-Inspired Technology)
Van Gerwen, Dennis J. (ForceSense B.V.)

2023

Introduction: We systematically describe the morphology and accessibility of interspinous spaces across age groups of patients. Our primary goal was to objectively estimate if the maneuver space for a virtual spinal needle changes with age. Our secondary goal was to estimate if the optimal site and angle for midline neuraxial puncture change with age. Methods: Measurements were performed in mid-sagittal CT images. The CT images were retrospectively collected from the database of the Department of Radiology of our hospital. Three age groups were studied: 21-30 years (n=36, abbreviated Y(oung)), 51-60 years (n=43, abbreviated M(iddle-aged)) and older than 80 years (n=46, abbreviated Old). A needle trajectory is defined by the chosen puncture point and by the angle at which the needle is directed to its target. We define a Spinal Accessibility Index (SAI) by numerically integrating for an interspace all possible combinations of puncture points and angles that lead to a successful virtual puncture. Successful in this context means that the needle tip reaches the spinal or epidural space without bone contact. Reproducible calculation of the SAI was performed with the help of custom-made software. The larger the value of the SAI, the more possible successful needle trajectories exist that the practitioner may choose from. The optimal puncture point and optimal angle in an age group at a certain level of the spine are defined by the combination of these two, which generates the highest success rate of the entire sample of this age group. Results: At all levels of the spine, the median SAI differed significantly between age groups (independent-samples Kruskal-Wallis test, p<0.001-0.047). The SAI consistently decreased with increasing age. Post-hoc analyses using pairwise comparisons showed a significantly higher SAI in group Y versus Old at all levels (p<0.001 - 0.006) except at level thoracic (Th)1-Th2 (p=0.138). The SAI was significantly higher in group M versus Old at all levels (p<0.001-0.028) except at level Th1-Th2 (p=0.061), Th4-Th5 (p=0.083), Th9-Th10 (p=1.00) and Th10-Th11 (p=1.00). Conclusions: Needle maneuver space in midline neuraxial puncture significantly decreases with progressive age at all levels of the spine. Optimal puncture points and angles are similar between age groups.

Anesthesia, Local
Injections, Spinal
Patient Simulation

http://resolver.tudelft.nl/uuid:5cd62445-faae-425e-a702-19b6c20494d7

https://doi.org/10.1136/rapm-2023-104981

2024-05-11

1098-7339

Regional Anesthesia and Pain Medicine

Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.

Institutional Repository

journal article

© 2023 Martin Hagenaars, J.J. van den Dobbelsteen, Dennis J. Van Gerwen