Predicting the Difficulty Score of Spinal Anaesthesia

Background: Spinal anaesthesia is the commonest regional anaesthesia conducted for several surgical procedures. Objectives: This study aims to predict the difficulty score of spinal anaesthesia to scale back the complications and ultimately improve anaesthesia quality. Materials and Methods: Patients undergoing various surgeries involving spinal anaesthesia were taken in this study and several parameters like demographic details, body mass index, spinous process condition were recorded pre operatively to see how they influenced the difficulty of performing spinal anesthesia on them. Results: Out of the 101 patients enrolled in this study, 53 underwent an easy SA by the first attempt in the first space. It was moderate in 36 and difficult in 12 patients. Conclusion: Considering the examination of patients with respect to BMI, lumbar spinous process status and deformities, radiological signs of lumbar vertebrae can be helpful in predicting how difficult the SA procedure is going to be.

Lumbar spinous process-splitting technique for ligamentum flavum cyst removal: the first use in Europe.

Background Laminotomy for lumbar stenosis is a well-defined procedure and represents a routine in every neurosurgical department. It is a common experience that the mono- or bilateral paraspinal muscles detachment together with supra and interspinous ligaments injury can lead to postoperative pain. In literature has been reported the application at the level of the lumbar spine of a minimally invasive technique defined as lumbar spinous process-splitting technique (LSPST). Methods In the current study, we present a case series of 12 patients that underwent LSPSL from September 2019 to April 2020. Two patient suffering from ligamentum flavum cyst, 8 patients with single level lumbar canal stenosis (LCS) and two patients with two-level LCS. The approach was mini-open, with reduced soft tissue dissection and without paraspinal muscles injury. Moreover, a novel morphological classification of postoperative muscle atrophy is proposed as well as a volumetric analysis of the decompression achieved. Conclusion At our knowledge, this is the first description of this surgical technique and the first LSPSL case series in Europe. Furthermore, cases of ligamentum flavum cyst removal using this safe and effective technique are not yet reported. Abbreviations Lumbar canal stenosis (LCS), lumbar spinous process-splitting technique (LSPST), minimally invasive spine surgery (MISS)

A Cadaveric Study on Lumbar Spinous Process Fusion: Risk Factor for Wrong Level Spinal Surgeries

Introduction: The fusion of Lumbar Spinous Processes (LSP) of adjacent vertebrae may lead to errors in determining the correct spinal level. This may result in wrong level spinal surgeries around the lumbar region. Aim: To determine the prevalence of fusion between adjacent LSP. Materials and Methods: This study was a prospective observational study done in the Department of Anatomy, Smt. B.K. Shah Medical Institute and Research Centre, Vadodara, Gujarat, India. The present study had examined the lumbar spines in 30 formalin preserved cadavers. The fusion between the LSP of adjacent vertebrae was recorded after the removal of soft tissue from L1 to S1 vertebrae. Results: The present study found the fusion between the adjacent LSP in 11 (36.67%) cadavers (08 males; 03 females). The fusion between the adjacent LSP, from L4 to S1 vertebrae, was found in 10% of cadavers and was the most common pattern. The fusion between the adjacent LSP was more common in males (53.3%) compared to females (20%). Conclusion: The occurrence of fusion between the adjacent LSP is not uncommon.