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Related Experiment Video

Updated: May 20, 2025

Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review

Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review

Published on: November 8, 2024

Fluoroscopic-guided Lumbar Subarachnoid Drain Placement: A Technical Report.

James T Lloyd¹, Scott S Cao¹, James C Simpson¹

¹Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Journal of Cardiothoracic and Vascular Anesthesia

|March 25, 2025

Summary

Anesthesiologists now routinely use fluoroscopy for lumbar drain placement, improving accuracy and reducing complications during aortic repair surgeries. This imaging guidance is particularly beneficial for patients with complex spinal anatomy.

Keywords:

fluoroscopic guided lumbar drain spinal cord ischemia subarachnoid drain vascular anesthesia

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Published on: January 31, 2025

Area of Science:

Anesthesiology
Neurosurgery
Vascular Surgery

Background:

Spinal cord ischemia is a significant risk during aortic repair.
Lumbar subarachnoid drains are used prophylactically.
Traditional drain placement relies on landmarks or radiology consultation.

Purpose of the Study:

To describe the institutional experience and technical insights of routine fluoroscopic-guided lumbar drain placement by anesthesiologists.
To highlight the benefits of real-time imaging for drain placement in vascular and cardiac surgeries.

Main Methods:

Vascular anesthesiologists at the authors' institution adopted routine fluoroscopy for lumbar drain placement in 2018.
Development of refined approaches and protocols over six years.
Application in diverse patient populations, including those with complex anatomies.

Main Results:

Over 175 successful fluoroscopic-guided lumbar drain placements were performed.
Reduced traumatic placements and case cancellations were observed.
Fluoroscopic guidance proved especially useful in patients with prior spine surgery, anatomical variances, and obesity.

Conclusions:

Routine fluoroscopic guidance enables anesthesiologists to perform accurate lumbar drain placements.
This technique reduces adverse outcomes and streamlines operating room workflow.
The institutional experience provides a model for other centers seeking to implement similar programs.