Hashiguchi Naofumi, Fujiwara Yasushi, Sato Nanoha, Matsumoto Akiko, Murakami Yasushi, Kotaka Shinji, Ota Ryo, Adachi Nobuo
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-0037, Japan.
Department of Orthopaedic Surgery/ Microscopic Spine and Spinal Cord Center, Hiroshima City North Medical Center Asa Citizens Hospital, 1-2-1 Kameyama Minami, Asakita-Ku, Hiroshima City, Hiroshima, 734-0037, Japan.
J Med Ultrason (2001). 2025 Sep 12. doi: 10.1007/s10396-025-01576-7.
Accurate identification of lumbar vertebral levels is crucial for the success of various interventional procedures, but conventional fluoroscopic guidance exposes both patients and physician to radiation. While ultrasound has emerged as a potential radiation-free alternative, its accuracy in elderly patients with spinal deformities remains unclear.
In this single-center cross-sectional study, we compared ultrasound-guided versus palpation-guided lumbar level identification in 115 patients scheduled for lumbar surgery between July 2019 and January 2020. Patients were randomly assigned to ultrasound guidance (U group, n = 57) or conventional palpation (P group, n = 58). The primary outcome measure was accuracy of vertebral level identification, verified by intraoperative fluoroscopy.
The U group demonstrated significantly higher accuracy (82.5%) compared to the P group (50.0%) (p = 0.0003, 95% CI [1.5-4.4]). Accuracy was particularly high at the L4 level (U group: 90.3%, P group: 55.9%, p = 0.0023). After adjusting for age and planned needle insertion site, ultrasound guidance maintained superior accuracy (OR = 5.5, 95% CI: 2.3-14.0, p = 0.0002).
Ultrasound guidance provides superior accuracy in lumbar level identification compared to conventional palpation, even in elderly patients with spinal deformities. This technique may offer a reliable, radiation-free alternative, potentially reducing radiation exposure while maintaining high accuracy.
准确识别腰椎椎体水平对于各种介入手术的成功至关重要，但传统的荧光透视引导会使患者和医生都暴露于辐射中。虽然超声已成为一种潜在的无辐射替代方法，但其在患有脊柱畸形的老年患者中的准确性仍不明确。
在这项单中心横断面研究中，我们比较了2019年7月至2020年1月期间计划进行腰椎手术的115例患者中超声引导与触诊引导下腰椎水平识别的情况。患者被随机分配至超声引导组（U组，n = 57）或传统触诊组（P组，n = 58）。主要结局指标是椎体水平识别的准确性，通过术中荧光透视进行验证。
与P组（50.0%）相比，U组显示出显著更高的准确性（82.5%）（p = 0.0003，95%CI[1.5 - 4.4]）。在L4水平准确性尤其高（U组：90.3%，P组：55.9%，p = 0.0023）。在调整年龄和计划的进针部位后，超声引导仍保持较高的准确性（OR = 5.5，95%CI：2.3 - 14.0，p = 0.0002）。
与传统触诊相比，超声引导在腰椎水平识别中提供了更高的准确性，即使在患有脊柱畸形的老年患者中也是如此。该技术可能提供一种可靠的、无辐射的替代方法，有可能在保持高准确性的同时减少辐射暴露。
