Ultrasound of the lumbar spine: Applications and advances

Lumbar neuraxial procedures are common for surgical, pain and diagnostic procedures with “blind” landmark palpation or radioactive imaging the current standards for locating needle insertion points. Improved ultrasound machine image quality, portability and computational speed force ultrasounds position in anesthesia to be reviewed. Modern studies show ultrasonography to have superior accuracy compared to blind landmark palpation for locating the correct interspinous level for central neuraxial procedures, resulting in increased spinal cord safety, higher first attempt success rates and a possible reduction in procedure time. These benefits appear greatest in patients with challenging procedural factors e.g. obesity, spinal abnormalities. Chronic pain procedure studies show ultrasonography has comparable accuracy to fluoroscopy, with the advantage of zero radiation exposure to patients and staff.