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Updated: Feb 19, 2026

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A Structured Ultrasound-Guided Workflow for Level Identification in Lumbar Spine Surgery.

Giuseppe Loggia1,2, Ellen M Soffin3, Fedan Avrumova1

  • 1Department of Spine Surgery, Hospital for Special Surgery, New York, NY.

Spine
|February 17, 2026
PubMed
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This summary is machine-generated.

Ultrasound (US) guidance accurately identifies lumbar spinal levels in cadavers. This novel four-step workflow offers a radiation-free alternative for surgical planning, achieving 98% accuracy in initial studies.

Area of Science:

  • Spinal Surgery
  • Medical Imaging
  • Anatomy

Background:

  • Wrong-level surgery is a significant complication, often requiring fluoroscopic verification.
  • Fluoroscopy involves ionizing radiation and specialized resources.
  • Ultrasound (US) is underutilized for surgical lumbar level identification (SLI).

Purpose of the Study:

  • To assess the accuracy of a structured four-step US-guided workflow for lumbar SLI.
  • To validate the protocol using cadaveric specimens.

Main Methods:

  • A novel four-step US protocol was applied to ten cadavers.
  • Steps included midline localization, sacral tracing, S1-superior articular process recognition, and interlaminar enumeration.
  • Spinal needles were placed under US guidance, with fluoroscopy confirming accuracy.
Keywords:
cadaverfluoroscopyspinal level identificationspineultrasonography

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Main Results:

  • 98% accuracy (49/50 levels) was achieved in lumbar SLI.
  • A single misidentification occurred at L5-S1.
  • The protocol demonstrated reproducibility without systematic errors.

Conclusions:

  • US-guided SLI using a structured four-step protocol is highly accurate in a cadaveric model.
  • This method provides a potential radiation-free alternative for preoperative lumbar level verification.
  • Further clinical validation is recommended.