Real-time ultrasound-guided spinal anesthesia in patients with a challenging spinal anatomy: two case reports

Acta Anaesthesiol Scand. 2010 Feb;54(2):252-5. doi: 10.1111/j.1399-6576.2009.02112.x. Epub 2009 Oct 15.


Spinal anesthesia may be challenging in patients with poorly palpable surface landmarks or abnormal spinal anatomy. Pre-procedural ultrasound imaging of the lumbar spine can help by providing additional anatomical information, thus permitting a more accurate estimation of the appropriate needle insertion site and trajectory. However, actual needle insertion in the pre-puncture ultrasound-assisted technique remains a 'blind' procedure. We describe two patients with an abnormal spinal anatomy in whom ultrasound-assisted spinal anesthesia was unsuccessful. Successful dural puncture was subsequently achieved using a technique of real-time ultrasound-guided spinal anesthesia. This may be a useful option in patients in whom landmark-guided and ultrasound-assisted techniques have failed.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anesthesia, Spinal / instrumentation
  • Anesthesia, Spinal / methods*
  • Anesthetics, Local / administration & dosage
  • Bupivacaine / administration & dosage
  • Dura Mater / diagnostic imaging
  • Female
  • Humans
  • Ligamentum Flavum / diagnostic imaging
  • Lumbar Vertebrae / abnormalities*
  • Lumbar Vertebrae / diagnostic imaging
  • Male
  • Needles
  • Scoliosis / diagnostic imaging
  • Spinal Canal / diagnostic imaging
  • Spinal Fusion
  • Transducers
  • Ultrasonography, Interventional / methods*


  • Anesthetics, Local
  • Bupivacaine