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Updated: May 19, 2026
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Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia
Published on: January 31, 2025
Correlation between spinous process dimensions and ease of spinal anaesthesia.
Hariharan Shankar1, Kanishka Rajput, Karthik Murugiah
1Department of Anesthesiology, Clement Zablocki VA Medical Center, Milwaukee, WI, USA.
Indian Journal of Anaesthesia
|August 28, 2012
Summary
The interspinous gap (ISG) is a key predictor of spinal anesthesia difficulty. A smaller ISG correlates with more attempts and levels needed for successful neuraxial blockade.
Area of Science:
- Anesthesiology
- Neurosurgery
- Anatomical Measurements
Background:
- Neuraxial anesthesia is common but presents technical challenges.
- Complications include post-dural puncture headache, neural trauma, and neuraxial hematoma.
- Interspinous gap (ISG) and spinous process width (SPW) may predict ease of access.
Purpose of the Study:
- To investigate ISG and SPW as objective measures for predicting neuraxial space access.
- To determine if these anatomical landmarks correlate with the difficulty of spinal anesthesia procedures.
Main Methods:
- Prospective enrollment of 202 patients undergoing spinal anesthesia.
- Measurement of ISG and SPW at the intended level using calipers.
- Recording of needle placement attempts, redirections, and levels used.
Main Results:
- The ISG was the single independent predictor of difficult neuraxial blocks.
- Patients needing >1 attempt had a mean ISG of 6.35 mm vs. 8.15 mm for single attempts (P=0.000).
- Patients needing >1 level had a mean ISG of 6.03 mm vs. 8.07 mm for single levels (P=0.000).
Conclusions:
- The ISG is the sole independent predictor of ease or difficulty in spinal anesthesia.
- ISG measurements can potentially guide anesthesiologists in anticipating and managing procedural challenges.
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