The Validation of Ultrasound-Guided Target Segment Identification in Thoracic Spine as Confirmed by Fluoroscopy

• Published in: Clinics in orthopedic surgery 2017, 9(4), , pp.472-479
• Main Authors: Heo, Ju-Yeong, Lee, Ji-Won, Kim, Cheol-Hwan, Lee, Sang-Min, Choi, Yong-Soo
• Format: Article
• Language: English
• Subjects: Adult; Anatomic Landmarks - diagnostic imaging; Cervical Vertebrae - diagnostic imaging; Fluoroscopy; Healthy Volunteers; Humans; Original; Ribs - diagnostic imaging; Thoracic Vertebrae - diagnostic imaging; Ultrasonography; Young Adult; 정형외과학
• ISSN: 2005-291X; 2005-4408
• DOI: 10.4055/cios.2017.9.4.472

The role of ultrasound in the thoracic spine has been underappreciated, partly because of the relative efficacy of the landmark-guided technique and the limitation of imaging through the narrow acoustic windows produced by the bony framework of thoracic spine. The aim of this study was to make a comparison between the 12th rib and the spinous process of C7 as a landmark for effective ultrasound-guided target segment identification in the thoracic spine. Ultrasonography of 44 thoracic spines was performed and the same procedure was carried out 1 week later again. The target segments (T3-4, T7-8, and T10-11) were identified using the 12th rib (group 1) or the spinous process of C7 (group 2) as a starting landmark. Ultrasound scanning was done proximally (group 1) or distally (group 2) toward the target transverse process and further medially and slightly superior to the target thoracic facet. Then, a metal marker was placed on the T3-4, T7-8, and T10-11 and the location of each marker was confirmed by fluoroscopy. In the total 132 segments, sonographic identification was confirmed to be successful with fluoroscopy in 84.1% in group 1 and 56.8% in group 2. Group 1 had a greater success rate in ultrasound-guided target segment identification than group 2 ( = 0.001), especially in T10-11 (group 1, 93.2%; group 2, 43.2%; = 0.001) and T7-8 (group 1, 86.4%; group 2, 56.8%; = 0.002). The intrarater reliability of ultrasound-guided target segment identification was good (group 1, = 0.76; group 2, = 0.82), showing no difference between right and left sides. Ultrasound-guided target segment identification was more effective in the non-obese subjects ( = 0.001), especially in group 1. Ultrasound-guided detection using the 12th rib as a starting landmark for scanning could be a promising technique for successful target segment identification in the thoracic spine.