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Spinal Anatomy Ultrasound in Young Infants With Implications for Lumbar Puncture
Margaret B Rinaldi1, Matthew Lipton2, Rebecca Kidd3
1Department of Pediatrics, Division of Pediatric Emergency Medicine, Medical University of South Carolina, Charleston, SC.
Insights
Ultrasound (US) imaging before lumbar puncture (LP) in infants shows larger spinal canal width and subarachnoid fluid width at higher lumbar levels. Infant weight is the key predictor for needle insertion depth during LPs.
Area of Science:
- Pediatric Emergency Medicine
- Medical Imaging
- Neonatal Care
Background:
- Lumbar puncture (LP) in infants presents challenges due to anatomical variability and procedural infrequency.
- Ultrasound (US) can aid in visualizing infant spinal anatomy for improved LP site selection.
Purpose of the Study:
- To evaluate US-guided lumbar puncture (LP) sites (L2/L3-L5/S1) in infants.
- To compare needle insertion depth (NID), spinal canal width (SCW), and subarachnoid fluid width (SAW) across different lumbar levels.
- To identify predictors of NID, including infant demographics.
Main Methods:
- A convenience sample of 50 infants (0-6 months) underwent spinal US in a pediatric emergency department.
- Paired t-tests and multiple linear regression models were used to analyze US measurements and predict NID.
- Measurements included SCW, SAW, and NID at lumbar interspaces L2/L3 through L5/S1.
Main Results:
- No significant difference in mean NID was found across L2/L3-L5/S1 levels.
- SCW and SAW were significantly larger at more cephalad (higher) lumbar levels.
- Infant weight was the sole significant predictor of NID after covariate adjustment.
Conclusions:
- Higher lumbar interspaces (e.g., L2/L3) offer larger spinal canal and subarachnoid fluid widths for potential LP.
- Subarachnoid fluid width is consistently small, emphasizing the need for precise needle placement.
- Infant weight can estimate NID, though the clinical significance of minor depth variations remains uncertain.
Background:
Lumbar puncture (LP) in young infants may challenge clinicians due to the infrequency of the procedure and anatomic variability. The use of ultrasound (US) to characterize young infant spinal anatomy prior to performing an LP may help determine the most favorable site for intervention.
Objectives:
1) Evaluate potential sites for LP in young infants with US at L2/L3 through L5/S1 to determine differences in needle insertion depth (NID), spinal canal width (SCW), and subarachnoid fluid width (SAW).2) Describe the location of the conus medullaris.3) Predict NID of L2/L3 through L5/S1 based on variables including age, gestational age, height, and weight.
Methods:
We studied a convenience sample of participants aged 0-6 months in a tertiary children's emergency department. We recorded characteristic data and used a Sonosite PX US with a linear 15-MHz transducer to image each participant's spine. We used the paired t -test to examine univariate differences in NID, SCW, and SAW and multiple linear regression models to derive predictive equations for NID.
Results:
Among 50 participants, the mean NID for sites L2/L3 through L5/S1 did not differ significantly; however, at sites L2/L3 through L5/S1, there were statistically significant differences in the mean SCW and mean SAW, which were both consistently measured to be larger the more cephalad the site. Weight was the only statistically significant variable associated with NID after adjusting for other covariates.
Conclusions:
Spinal canal width and SAW were consistently measured to be larger at more cephalad sites, suggesting there is a larger target fluid volume available at higher interspaces. Subarachnoid fluid width was measured to be small, highlighting the importance of precise movements. Location of the needle site did not change expected needle depth (approximately 1 cm across all sites). The conus medullaris was not often visualized while scanning the L2/L3-L5/S1 interspaces. Weight can be used to estimate optimal NID; although, it is unclear such small differences would have clinical significance.
