Clin Orthop Surg.  2017 Dec;9(4):472-479. 10.4055/cios.2017.9.4.472.

The Validation of Ultrasound-Guided Target Segment Identification in Thoracic Spine as Confirmed by Fluoroscopy

• Heo JY
• Lee JW
• Kim CH
• Lee SM
• Choi YS

• KMID: 2412248
• DOI: http://doi.org/10.4055/cios.2017.9.4.472

Abstract

BACKGROUND
The role of ultrasound in the thoracic spine has been underappreciated, partly because of the relative efficacy of the landmark-guided technique and the limitation of imaging through the narrow acoustic windows produced by the bony framework of thoracic spine. The aim of this study was to make a comparison between the 12th rib and the spinous process of C7 as a landmark for effective ultrasound-guided target segment identification in the thoracic spine.
METHODS
Ultrasonography of 44 thoracic spines was performed and the same procedure was carried out 1 week later again. The target segments (T3-4, T7-8, and T10-11) were identified using the 12th rib (group 1) or the spinous process of C7 (group 2) as a starting landmark. Ultrasound scanning was done proximally (group 1) or distally (group 2) toward the target transverse process and further medially and slightly superior to the target thoracic facet. Then, a metal marker was placed on the T3-4, T7-8, and T10-11 and the location of each marker was confirmed by fluoroscopy.
RESULTS
In the total 132 segments, sonographic identification was confirmed to be successful with fluoroscopy in 84.1% in group 1 and 56.8% in group 2. Group 1 had a greater success rate in ultrasound-guided target segment identification than group 2 (p = 0.001), especially in T10-11 (group 1, 93.2%; group 2, 43.2%; p = 0.001) and T7-8 (group 1, 86.4%; group 2, 56.8%; p = 0.002). The intrarater reliability of ultrasound-guided target segment identification was good (group 1, r = 0.76; group 2, r = 0.82), showing no difference between right and left sides. Ultrasound-guided target segment identification was more effective in the non-obese subjects (p = 0.001), especially in group 1.
CONCLUSIONS
Ultrasound-guided detection using the 12th rib as a starting landmark for scanning could be a promising technique for successful target segment identification in the thoracic spine.

Keyword

Thoracic spine; Ultrasonography; Nerve block

MeSH Terms

Adult
Anatomic Landmarks/*diagnostic imaging
Cervical Vertebrae/*diagnostic imaging
Fluoroscopy
Healthy Volunteers
Humans
Ribs/*diagnostic imaging
Thoracic Vertebrae/*diagnostic imaging
*Ultrasonography
Young Adult

Figure

• 

  Fig. 1 Ultrasound images of the detection method using the 12th rib as a starting landmark. The double-lined rectangle represents the ultrasound probe. (A) The 12th rib in the sagittal view. (B) The transverse process of T12 was found medial to the 12th rib. (C) The probe was moved proximally to the transverse process of T7 and T8. (D) The facet joint of T7–8 was found medially and slightly proximal to the transverse process.

• 

  Fig. 2 Metal makers (black arrows) placed at the target location identified with sonography.

• 

  Fig. 3 Validation by C-arm fluoroscopy. (A) Successful case: the metal marker was accurately located at the facet joint of the target segment. (B) Failure case: the metal marker was not accurately located at the facet joint of the target segment.

• 

  Fig. 4 Ultrasound images of the detection method using the spinous process of C7 as a starting landmark. The double-lined rectangle represents the ultrasound probe. (A) The spinous process of C7 in the sagittal view. (B) The transverse process of T1 was found lateral to the spinous process of C7. (C) The probe was moved distally to the transverse process of T3 and T4. (D) The facet joint of T3–4 was found medially and slight proximal to the transverse process.

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