POSITIONING FOR LUMBAR PUNCTURE, MEASURED BY ULTRASONOGRAPHY
R.KOSİF
1, M.ÖZARAR
2, B.TAŞ
3, A.ÖZENSOY
4, T.AYAZOĞLU
4
ABANT İZZET BAYSAL UNIVERTY MEDICAL FACULTY, ANATOMY DEPARTMENT. BOLU, TURKEY 1
FATIH SULTAN MEHMET TRAINING AND RESEARCH HOSPITAL, İSTANBUL, TURKEY 2
FATIH SULTAN MEHMET TRAINING AND RESEARCH HOSPITAL, İSTANBUL, TURKEY, 3
KARTAL KOSUYOLU HIGH SPECIALITY TRAINING AND RESEARCH HOSPITAL, İSTANBUL TURKEY 4
The purpose of this study was to identify the patient position for lumbar puncture associated with the widest interspinous distance utilizing ultrasound ıntroduction. There is no Standard, recommended, optimal position for patients who are undergoing the procedure. The procedure relies on the identification of the appropriate interspinous space by palpation of the bony prominences of the iliac crests ends of the spinous processes (1). The physician may choose the L3, L4 or L5 interspace, usualy based on which space appears to be widest by palpation of the spinous processes. The clinician may encounter difficulties such a calcified supraspinal ligament or spinal anomalies, resulting suboptimal needle placement, The objective of this study was to identify the patient position associated with the widest interspinous distance by measuring the interspinous space (between the spinous processes) using ultrasonography. We compared the two positions frequently used for lumbar puncture and a third position used in our department for the placement of spinal-epidural anesthesia.
31 healthy adult volunteers ( 14 men and 17 women, age range 17- 44 years, mean 27.3 years) were placed in different three positions. Positions of the patients were Lateral recumbent fetal position in position A, Sitting position with feet unsupported in position B, sitting position by extending the legs straight without hip and knees flexion in position C. Using a portable ultrasound device, the L3-L4 or L4- L5 interspinous space was measured in volunteers. Measurements were compared between the three positions
Our study showed that the interspinous distance was significantly great in the ‘’ C- sitting position by extending the legs straight without hip and knees flexion’’ position than in the other two positions frequently used for lumbar puncture (P<0.001).
we recommend this position for lumbar punctures especially in situations in which implementing of other two position fails.
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