Is spinal anaesthesia at L2–L3 interspace safe in disorders of the vertebral column? A magnetic resonance imaging study

Lin, N.; Bebawy, J. F.; Hua, L.; Wang, B. G.
December 2010
BJA: The British Journal of Anaesthesia;Dec2010, Vol. 105 Issue 6, p857
Academic Journal
Background The varying point at which the spinal cord terminates in the lumbar spinal canal may affect the incidence of spinal cord injuries associated with needle insertion for spinal anaesthesia, especially in patients with vertebral body or intervertebral disc disease. This is a complication which has been frequently reported when spinal needle insertion was performed at higher lumbar spinal levels. Methods We retrospectively reviewed magnetic resonance images of the spine in 1047 Chinese patients to determine the conus medullaris terminus (CMT) in patients with and without vertebral disorders. Patients with tumours in and around the spine and those with congenital spinal anomalies were excluded from the study. Patients with mixed vertebral disorders were also excluded. Results Our data demonstrate that patients with thoracic vertebral compression fractures had lower ending points of the CMT than those without (P<0.05), while patients with lumbar compression fractures did not demonstrate such a correlation. With regard to this difference, females were significantly at higher risk for a lower CMT than males. Conversely, lumbar disc disorders such as intervertebral disc extrusion, herniation, or bulging did not have any significant influence on the level of CMT. Moreover, patients with spondylolisthesis or scoliosis did not demonstrate an abnormal CMT location. Conclusions When performing spinal anaesthesia, anaesthesiologists should be aware of potential differences of the CMT location, particularly in female patients with thoracic vertebral compression fractures, who may have a lower CMT than normal, extending to the level of L2. Performing spinal anaesthesia at the L2–L3 interspace would seem to be ill-advised in this patient population.


Related Articles

  • Surfer’s myelopathy. Lin, C.-Y.; Fu, J.-H.; Li, S.-C.; Lai, P.-H. // QJM: An International Journal of Medicine;Apr2012, Vol. 105 Issue 4, p373 

    No abstract available.

  • Untitled. Kraus, Guenther J. // Applied Radiology;Nov2006, Vol. 35 Issue 11, p74 

    This article discusses the case of an older woman who experienced intramedullary bleeding after an inadvertent puncture of the medullary cone. The bleeding was due the inadvertent puncture during the administration of spinal anesthesia. This patient had paresthesia in her lower legs, including...

  • Intradural migration of a bullet following spinal gunshot injury. Kafadar, A. M.; Kemerdere, R.; Isler, C.; Hanci, M. // Spinal Cord;May2006, Vol. 44 Issue 5, p326 

    Study design:Case report.Objectives:To report a penetrating gunshot injury at L1 with migration within the spinal canal to S2.Setting:Istanbul, Turkey.Methods:A 44-year-old man was admitted with an entrance gunshot wound on the left upper quadrant. An emergency exploratory laparotomy with left...

  • Interrater reliability of identifying indicators of posterior ligamentous complex disruption when plain films are indeterminate in thoracolumbar injuries. Karl M. Schweitzer; Alexander R. Vaccaro; James S. Harrop; John Hurlbert; John A. Carrino; Glenn R. Rechtine; David G. Schwartz; Ahmet Alanay; Dinesh K. Sharma; D. Greg Anderson; Joon Y. Lee; Paul M. Arnold // Journal of Orthopaedic Science;Sep2007, Vol. 12 Issue 5, p437 

    Abstract Background  The Spine Trauma Study Group (STSG) has proposed a novel thoracolumbar injury classification system and score (TLICS) in an attempt to define traumatic spinal injuries and direct appropriate management schemes objectively. The TLICS assigns specific point values based...

  • Bifocal Spinal Cord Injury without Radiographic Abnormalities in a 5-Year Old Boy: A Case Report. Snoek, K. G.; Jacobsohn, M.; van As, A. B. // Case Reports in Pediatrics;2012, p1 

    We present the extremely unusual case of a 5-year-old boy with a bifocal (cervical as well as lumbar) spinal cord injury without radiographic abnormalities (SCIWORAs). The MRI showed cord oedema at the level of C2 and T10. We propose that during the motor vehicle crash severe propulsion of the...

  • Multiple capillary hemangiomas of the cauda equina at a level of a single vertebra. Funayama, Toru; Sakane, Masataka; Murai, Shinji; Ochiai, Naoyuki // Journal of Orthopaedic Science;Jul2010, Vol. 15 Issue 4, p598 

    No abstract available.

  • Aktuelle bildgebende Diagnostik der Wirbelsäulenerkrankungen. B. Baumert; J. Blautzik; M. Körner; M. Reiser; U. Linsenmaier // Der Chirurg;Oct2008, Vol. 79 Issue 10, p906 

    Zusammenfassung  Die radiologische Bildgebung stellt einen unerlässlichen Bestandteil in der Diagnostik von Wirbelsäulenerkrankungen dar. Als Basisdiagnostik steht initial unverändert die konventionelle Röntgenaufnahme (CR) im Vordergrund, mit der bereits in vielen Fällen...

  • Conus Medullaris Syndrome as a Complication of Radioisotope Cisternography. Park, Bek-San; Park, Jinse; Koh, Seong-Ho; Choi, Hojin; Yu, Hyun-Jeung; Lee, Koo-Eun; Lee, Young Joo; Lee, Kyu-Yong // Canadian Journal of Neurological Sciences;May2012, Vol. 39 Issue 3, p347 

    Objective: Conus medullaris syndrome (CMS) is a clinical neurologic syndrome caused by a conus medullaris lesion. CMS is a heterogeneous entity with various etiologies such as trauma or a space-occupying lesion. Multiple cases of CMS following spinal anesthesia have been reported, but CMS after...

  • MRI and discography in traumatic intervertebral disc lesions. Ghanem, Nadir; Uhl, Markus; Müller, Christoph; Elgeti, Florian; Pache, Gregor; Kotter, Elmar; Markmiller, Max; Langer, Mathias; Müller, Christoph // European Radiology;Nov2006, Vol. 16 Issue 11, p2533 

    In this study we evaluated magnetic resonance imaging (MRI) in trauma patients for assessing traumatised adjacent discs of fractured vertebrae before dorsoventral stabilisation. In a prospective study, MRI of 54 discs was performed with a 1.5-T MRI unit. The preoperative MRI with sagittal...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics