Lumbar Erector Spinae Plane Block for Posterior–Superior Iliac Spine Bone Graft Site Pain in Patients Undergoing Occipitocervical and C1–C2 Fusion for Atlantoaxial Dislocation/Odontoid Fracture—A Case Series

Pain at the autologous bone graft site from the posterior–superior iliac spine (PSIS) is severe enough to affect the postoperative ambulation. It adds to the morbidity of the surgical procedure. Inadequate pain management at the graft site not only affects the postoperative recovery but also can lead to chronic pain. We report the use of ultrasound (US)-guided lumbar erector spinae plane block (ESPB), to deliver effective analgesia for this pain. Patients who underwent occipitocervical fusion (OCF) and C1–C2 fusion using PSIS for atlantoaxial dislocation (AAD)/odontoid fracture from January to March 2020 and who received US-guided lumbar ESPB were retrospectively studied. All the necessary data were collected from the inpatient hospital, anesthesia, and the acute pain service records. A total of six patients received lumbar ESPB, of which one received a single shot injection, and the rest five had a catheter placement for postoperative analgesia. The average volume of intraoperative and postoperative bolus was 27(range: 15–30) and 21 (range: 15–30) mL of 0.2% ropivacaine, respectively. All patients achieved a unilateral sensory blockade ranging from L1 to L3 dermatomes. None of our patients had a numerical rating scale of > 4 on movement at any time point during the first 48 hours except in one, in whom only a single shot bolus was given. No complications related to ESPB were noted. All were ambulated on the second postoperative day except one. The average length of hospital stay was 6 (range: 4–10) days. US-guided lumbar ESPB provides excellent analgesia for PSIS bone graft site pain and promotes early ambulation.

The SpinalMeter biometrical assessment to improve posture diagnosis in school-age girls: a validation study

Introduction: Assessing spinal deformities using an X-ray radiation is the method of choice for posture diagnosis. It is also used for the evaluation of the degree of correction, brace fit, and spinal balance as well as for further management decisions. However, multiple X-ray exposures during control visits could be too burdensome for children. Aim: The aim of this study was to investigate the precision and repeatability of measurement of the variables obtained by a fast, simple postural evaluation in children by the SpinalMeter. Material and methods: The measurements of the angle of trunk rotation (ATR) and SpinalMeter posture assessments were performed 8 to 10 times in a short period of time (6 s). The overall of 300 photos (SpinalMeter) and 1020 measurements (asymmetry, distance between anthropometric points as well as ATR) were obtained from 6 girls (8–15 years old). The validation study comprised of the repeatability, interclass correlation coefficient (Qw) and relative standard deviation (rSD) measurements. Results and discussion: The measurements of the distance between acromion–popliteal fossa, acromion–iliac crest, and acromion–posterior superior iliac spine obtained by SpinalMeter were clearly repeatable (Qw > 0.9). The scapular and pelvic asymmetry in standing and sitting positions were highly repeatable and had low rSD (e.g. for scapular asymmetry 5.6%–80.3%; Qw > 0.8). Conclusions: The precise and reliable postural biometrical measurements were performed by SpinalMeter in the case of the distance between anthropometric points and asymmetry of pelvis and scapula. These measurements could be useful in the assessment of girl’s posture when visiting the pediatrician.

Discriminant analysis of the relationship between estimated spinal level of posterior superior iliac spine (PSIS) and spinal-pelvic parameters

Background: The spinal level determined by reference of posterior superior iliac spine (PSIS) will be different because of the various sagittal posture of spine-pelvis complex. The study aimed at investigating the anatomical factors affecting the estimated spinal level of PSIS from the standpoint of spine-pelvis paraments, and provided a basis for improving the accuracy of positioning. Methods: The lumbar X-ray images of 76 patients were retrospectively analyzed. The population was classified according to the estimated level of PSIS. lumbar lordosis (LL), sacral slope (SS), pelvic incidence (PI), pelvic tilt (PT) and other parameters were measured. Then, the latent factors affecting the estimated level were filtered and obtained by One-way ANOVA and Fisher linear discriminant analysis to further summarize the imaging characteristics of different populations. Results: Three different levels of L5 (10 cases), S1 (46 cases) and S2 (20 cases) were observed. ANOVA analysis showed that LL, SS, PT, PI, SS-PT, LL-SS and lordosis of L1-L5 (LL L1-L5 ) were significantly different among the three groups ( P < 0.05). Discriminant analysis showed that LL, SS, SS-PT and LL L1-L5 were the main factors affecting the estimated level of PSIS (P < 0.05). Conclusions: The variations of morphological parameters such as LL, SS, SS-PT and LL L1-L5 can affect the estimated level of PSIS, and the level can be predicted by the discriminant function. In the study, the function is D=-4.458+0.13×LL-0.115×SS+0.45× （SS-PT）+0.39×LL L1-L5 , which proved 71.1％ of the discriminant accuracy rate.

Feasibility and safety of targeting the anterior superior iliac spine to perform a bone marrow procedure: a prospective, clinical study

AimsThe bone marrow procedure (BMP) has been performed worldwide for years. Nonetheless, no generally accepted standards or guidelines for the performance of the BMP exist. Recent studies suggested that the lateral angulation technique (LAT), targeting the anterior superior iliac spine (ASIS) after penetration of the posterior superior iliac spine, yields longer biopsy cores and is safer for patients. We assessed the feasibility and safety of targeting the ASIS in the prone and lateral decubitus positions.MethodsWe first observed the BMP needle tracks on cadavers. Our cadaver study revealed that the LAT is feasible and safe but requires different operator techniques. Next, we studied 25 adult haematology patients undergoing elective BMP via the LAT approach. Patients returned 5 days after the BMP for a haemoglobin assessment, pain questionnaire and low-dose non-contract CT.Results8% of patients reported persistent pain. No fall in haemoglobin and no pelvic haematomas or neurovascular injuries were detected. 88% of BMPs were successfully accomplished by targeting the ASIS. 12% required a back-up traditional angulation technique (TAT), directing the needle straight in, perpendicular to the coronal plane of the back. All three demonstrated inadvertent, but asymptomatic, penetration of the sacrum. Biopsy lengths were compared with a historical TAT control demonstrating that specimens obtained by LAT are significantly longer. Imaging studies showed that a seven-degree change in needle direction can convert a TAT to a LAT.ConclusionThe LAT approach is feasible, safe and more productive than the TAT, and may be the preferred standard for training haematologists.Trial registration numberNCT02524613.

The posterior superior iliac spine and sacral laminar slope: key anatomical landmarks for freehand S2-alar-iliac screw placement

OBJECTIVEThe S2-alar-iliac (S2AI) screw is an increasingly popular method for spinopelvic fixation. The technique of freehand S2AI screw placement has been recently described. The purpose of this study was to demonstrate, through a CT imaging study of patients with spinal deformity, that screw trajectories based on the posterior superior iliac spine (PSIS) and sacral laminar slope result in reliable freehand S2AI trajectories that traverse safely above the sciatic notch.METHODSFifty consecutive patients (age ≥ 18 years) who underwent primary spinal deformity surgery were included in the study. Simulated S2AI screw trajectories were analyzed with 3D visualization software. The cephalocaudal coordinate for the starting point was 15 mm cephalad to the PSIS. The mediolateral coordinate for the starting point was in line with the lateral border of the dorsal foramina. The cephalocaudal screw trajectory was perpendicular to the sacral laminar slope. Screw trajectories, lengths, and distance above the sciatic notch were measured.RESULTSThe mean sagittal screw angle (cephalocaudal angulation) was 44.0° ± 8.4° and the mean transverse angle (mediolateral angulation) was 37.3° ± 4.3°. The mean starting point was 5.9 ± 5.8 mm distal to the caudal border of the S1 foramen. The mean screw length was 99.9 ± 18.6 mm. Screw trajectories were on average 8.5 ± 4.3 mm above the sciatic notch. A total of 97 of 100 screws were placed above the sciatic notch. In patients with transitional lumbosacral anatomy, the starting point on the lumbarized/sacralized side was 3.4 mm higher than on the contralateral unaffected side.CONCLUSIONSThe PSIS and sacral laminar slope are two important anatomical landmarks for freehand S2AI screw placement.