Ultrasound-Guided Spine Anesthesia: Feasibility Study of a Guidance System

Abstract

Spinal needle injections are guided by fluoroscopy or palpation, resulting in radiation exposure and/or multiple needle re-insertions. Consequently, guiding these procedures with live ultrasound has become more popular, but images are still challenging to interpret. We introduce a guidance system based on augmentation of ultrasound images with a patient-specific 3-D surface model of the lumbar spine. We assessed the feasibility of the system in a study on 12 patients. The system could accurately provide augmentations of the epidural space and the facet joint for all subjects. Following conventional, fluoroscopy-guided needle placement, augmentation accuracy was determined according to the electromagnetically tracked final position of the needle. In 9 of 12 cases, the accuracy was considered sufficient for successfully delivering anesthesia. The unsuccessful cases can be attributed to errors in the electromagnetic tracking reference, which can be avoided by a setup reducing the influence of the metal C-arm.

Keywords: Epidural needle insertions; Facet joint injections; Guidance; Model-based registration; Ultrasound.