ArticleNeuroSci2025
The Transverse Process as a Landmark for Estimating Dural Sac Depth and Feasible Planes for Optimized Paramedian Needle Insertions.
Article in NeuroSci, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07210892 (Paramedian Incidence Angles in Spinal Anaesthesia), which is not on this map. Not yet cited in PubMed.
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Paramedian Incidence Angles in Spinal Anaesthesia
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4 authors.
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Abstract
backgroundThe skin-to-transverse process distance (st) correlates with the skin-to-dural sac depth (d) and may be used to estimate optimal angles for perpendicular needle insertion using the formula inverse cosine d/√(1 + d
objectiveWe aimed to analyze the relationship between the transverse process and dural sac depth at lumbar levels relevant to spinal anesthesia and to determine the range of planes where perpendicular paramedian needle insertion is feasible when midline access is not viable.
methodsTen ex vivo trunks were flexed using an abdominal support, and CT scans were performed. Correlations between the transverse process and dural sac depth were evaluated from L3 to S1. Perpendicular planes at the level of needle paths were examined at L3-L4 and L4-L5. Median path viability was assessed.
resultsThe transverse process aligned with the dorsal dural sac at L3, the posterior third at L4, and the middle zone at L5 or S1. Median needle insertion was not viable in 20-30% of L4-L5 and L3-L4 levels, respectively. However, paramedian access was possible. The vertical range of viable paramedian planes was 8.7 ± 2.9 mm (L4-L5) and 7.9 ± 1.9 mm (L3-L4). Coronal reconstructions showed that the upper level of the transverse process correlates with the skin-perpendicular planes where insertion is likely to succeed.
conclusionMany elderly spines lack viable midline paths. The superior aspect of the transverse process serves as a useful landmark for estimating dural sac depth, calculating paramedian angles, and identifying the plane for successful perpendicular needle insertion.
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