Hagenaars Martin, van den Dobbelsteen John J, van Gerwen Dennis J
Anesthesiology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
Delft University of Technology, Department of Biomechanical Engineering, Delft, The Netherlands.
Reg Anesth Pain Med. 2024 Dec 2;49(12):853-860. doi: 10.1136/rapm-2023-104981.
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.
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 of puncture and 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.
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).
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.
我们系统地描述了不同年龄组患者棘突间间隙的形态和可达性。我们的主要目标是客观评估虚拟脊椎穿刺针的操作空间是否随年龄变化。我们的次要目标是评估中线神经轴穿刺的最佳部位和角度是否随年龄变化。
在矢状位CT图像上进行测量。CT图像是从我院放射科数据库中回顾性收集的。研究了三个年龄组：21 - 30岁（n = 36，简称为青年组（Y））、51 - 60岁（n = 43，简称为中年组（M））和80岁以上（n = 46，简称为老年组）。针的轨迹由所选的穿刺点和针指向目标的角度定义。我们通过对穿刺间隙进行数值积分来定义一个脊髓可达性指数（SAI），该积分会产生成功的虚拟穿刺。在本文中，成功意味着针尖在不接触骨骼的情况下到达脊髓或硬膜外腔。借助定制软件对SAI进行可重复计算。SAI的值越大，从业者可选择的成功针轨迹就越多。脊柱某一水平年龄组的最佳穿刺点和最佳角度由这两者的组合定义，该组合能使该年龄组的整个样本获得最高成功率。
在脊柱的所有水平，年龄组之间的SAI中位数差异显著（独立样本Kruskal - Wallis检验，p < 0.001 - 0.047）。SAI随年龄增长持续下降。使用两两比较的事后分析显示，除胸段（Th）1 - Th2水平（p = 0.138）外，青年组在所有水平的SAI均显著高于老年组（p < 0.001 - 0.006）。除Th1 - Th2水平（p = 0.061）、Th4 - Th5水平（p = 0.083）、Th9 - Th10水平（p = 1.00）和Th10 - Th11水平（p = 1.00）外，中年组在所有水平的SAI均显著高于老年组（p < 0.001 - 0.028）。
在脊柱的所有水平，中线神经轴穿刺的针操作空间随年龄增长显著减小。各年龄组的最佳穿刺点和角度相似。
