Biomedical Engineering Department, College of Engineering, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia.
Department of Mechanical and Energy Engineering, College of Engineering, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia.
Sensors (Basel). 2023 Jun 30;23(13):6065. doi: 10.3390/s23136065.
Lumbar puncture is a minimally invasive procedure that utilizes a spinal needle to puncture the lumbar epidural space to take a sample from the cerebrospinal fluid or inject drugs for diagnostic and therapeutic purposes. Physicians rely on their expertise to localize epidural space. Due to its critical procedure, the failure rate can reach up to 28%. Hence, a high level of experience and caution is required to correctly insert the needle without puncturing the dura mater, which is a fibrous layer protecting the spinal cord. Failure of spinal anesthesia is, in some cases, related to faulty needle placement techniques since it is blindly inserted. Therefore, advanced techniques for localization of the epidural space are essential to avoid any possible side effects. As for epidural space localization, various ideas were carried out over recent years to provide accurate identification of the epidural space. Subsequently, several methodologies based on mechanical and optical schemes have been proposed. Several research groups worked from different aspects of the problem, namely, the clinical and engineering sides. Hence, the main goal of this paper is to review this research with the aim of remedying the gap between the clinical side of the problem and the engineering side by examining the main techniques in building sensors for such purposes. This manuscript provides an understanding of the clinical needs of spinal needles from an anatomical point of view. Most importantly, it discusses the mechanical and optical approaches in designing and building sensors to guide spinal needles. Finally, the standards that must be followed in building smart spinal needles for approval procedures are also presented, along with some insight into future directions.
腰椎穿刺是一种微创程序，利用脊柱针穿刺腰椎硬膜外腔，从脑脊液中取样或注射药物用于诊断和治疗目的。医生依靠他们的专业知识来定位硬膜外腔。由于其关键程序，失败率可达 28%。因此，需要高水平的经验和谨慎，以正确插入针而不刺破保护脊髓的纤维层硬脑膜。在某些情况下，脊髓麻醉失败与针放置技术的错误有关，因为它是盲目插入的。因此，为了避免任何可能的副作用，定位硬膜外腔的先进技术是必不可少的。至于硬膜外腔定位，近年来提出了各种想法，以提供对硬膜外腔的准确识别。随后，提出了几种基于机械和光学方案的方法。几个研究小组从问题的临床和工程方面着手。因此，本文的主要目标是回顾这项研究，旨在通过检查用于此类目的的传感器的主要技术，弥补临床方面和工程方面之间的差距。本文从解剖学的角度理解了脊柱针的临床需求。最重要的是，它讨论了设计和构建传感器的机械和光学方法，以引导脊柱针。最后，还介绍了为获得批准程序而构建智能脊柱针所需遵循的标准，并对未来的方向提出了一些见解。
