{"title":"印度儿童不同椎体水平的硬脑膜到脊髓距离:一项基于计算机断层扫描的回顾性研究。","authors":"Heena Garg, Shailendra Kumar, Naren Hemachandran, Prabudh Goel, Devasenathipathy Kandasamy, Minu Bajpai, Puneet Khanna","doi":"10.4103/aer.aer_26_22","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Neuraxial techniques provide good postoperative analgesia for painful procedures in the pediatric population. However, any injury to the spinal cord can lead to irreversible long-term effects.</p><p><strong>Aims: </strong>We aimed to evaluate dura-to-cord (DTC) distance from computerized tomography (CT) images of thoracolumbar spine in pediatric age group (1-16 years) at T<sub>8-9</sub>, T<sub>9-10</sub>, and L<sub>1-2</sub> interspaces to identify the safe space for epidural insertion in Asian children.</p><p><strong>Settings and design: </strong>It was a retrospective study including 141 children aged 1-16 years who underwent routine CT scan of the thoracolumbar region for unrelated diagnostic indications.</p><p><strong>Materials and methods: </strong>Patients with spinal abnormalities were excluded. Sagittal CT images of the thoracolumbar spine were obtained to calculate the DTC at T<sub>8-9</sub>, T<sub>9-10</sub>, and L<sub>1-2</sub> interspaces. The measurements at all levels were obtained perpendicular to the long axis of the vertebral body.</p><p><strong>Statistical analysis used: </strong>Continuous data were depicted as mean with standard deviations. The categorical data were presented as counts with percentages.</p><p><strong>Results: </strong>The mean DTC distance at T<sub>8-9</sub>, T<sub>9-10</sub>, and L<sub>1-2</sub> interspaces was 3.51 ± 0.98 mm (95% confidence interval [CI]: 3.35-3.67), 2.73 ± 0.94 mm (95% CI: 2.57-2.89), and 2.83 ± 1.08 mm (95% CI: 2.66-3.02), respectively. A significant difference was found between the genders at T<sub>9-10</sub> (<i>P</i> = 0.02) and L<sub>1-2</sub> levels (<i>P</i> = 0.04). No difference in DTC was found in toddlers, preschool children, school-going children, and adolescents. DTC at T<sub>8-9</sub> showed a significant correlation with age (<i>R</i> <sup>2</sup> = 0.0479; <i>P</i> = 0.04), weight (<i>R</i> <sup>2</sup> = 0.038; <i>P</i> = 0.02), and height (<i>R</i> <sup>2</sup> = 0.037; <i>P</i> = 0.03).</p><p><strong>Conclusion: </strong>Thoracic epidural space can be used in children and adolescents for epidural catheter placement. T<sub>8-9</sub> level showed maximum DTC distance and significant correlation with age, height, and weight in CT imaging in the present study.</p>","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"16 1","pages":"138-142"},"PeriodicalIF":0.0000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9558667/pdf/","citationCount":"0","resultStr":"{\"title\":\"Dura-to-Spinal Cord Distance at Different Vertebral Levels in Indian Children: A Retrospective Computerized Tomography Scan-Based Study.\",\"authors\":\"Heena Garg, Shailendra Kumar, Naren Hemachandran, Prabudh Goel, Devasenathipathy Kandasamy, Minu Bajpai, Puneet Khanna\",\"doi\":\"10.4103/aer.aer_26_22\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Neuraxial techniques provide good postoperative analgesia for painful procedures in the pediatric population. However, any injury to the spinal cord can lead to irreversible long-term effects.</p><p><strong>Aims: </strong>We aimed to evaluate dura-to-cord (DTC) distance from computerized tomography (CT) images of thoracolumbar spine in pediatric age group (1-16 years) at T<sub>8-9</sub>, T<sub>9-10</sub>, and L<sub>1-2</sub> interspaces to identify the safe space for epidural insertion in Asian children.</p><p><strong>Settings and design: </strong>It was a retrospective study including 141 children aged 1-16 years who underwent routine CT scan of the thoracolumbar region for unrelated diagnostic indications.</p><p><strong>Materials and methods: </strong>Patients with spinal abnormalities were excluded. Sagittal CT images of the thoracolumbar spine were obtained to calculate the DTC at T<sub>8-9</sub>, T<sub>9-10</sub>, and L<sub>1-2</sub> interspaces. The measurements at all levels were obtained perpendicular to the long axis of the vertebral body.</p><p><strong>Statistical analysis used: </strong>Continuous data were depicted as mean with standard deviations. The categorical data were presented as counts with percentages.</p><p><strong>Results: </strong>The mean DTC distance at T<sub>8-9</sub>, T<sub>9-10</sub>, and L<sub>1-2</sub> interspaces was 3.51 ± 0.98 mm (95% confidence interval [CI]: 3.35-3.67), 2.73 ± 0.94 mm (95% CI: 2.57-2.89), and 2.83 ± 1.08 mm (95% CI: 2.66-3.02), respectively. A significant difference was found between the genders at T<sub>9-10</sub> (<i>P</i> = 0.02) and L<sub>1-2</sub> levels (<i>P</i> = 0.04). No difference in DTC was found in toddlers, preschool children, school-going children, and adolescents. DTC at T<sub>8-9</sub> showed a significant correlation with age (<i>R</i> <sup>2</sup> = 0.0479; <i>P</i> = 0.04), weight (<i>R</i> <sup>2</sup> = 0.038; <i>P</i> = 0.02), and height (<i>R</i> <sup>2</sup> = 0.037; <i>P</i> = 0.03).</p><p><strong>Conclusion: </strong>Thoracic epidural space can be used in children and adolescents for epidural catheter placement. T<sub>8-9</sub> level showed maximum DTC distance and significant correlation with age, height, and weight in CT imaging in the present study.</p>\",\"PeriodicalId\":7798,\"journal\":{\"name\":\"Anesthesia, Essays and Researches\",\"volume\":\"16 1\",\"pages\":\"138-142\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9558667/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Anesthesia, Essays and Researches\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4103/aer.aer_26_22\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/7/6 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Anesthesia, Essays and Researches","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/aer.aer_26_22","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/7/6 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
Dura-to-Spinal Cord Distance at Different Vertebral Levels in Indian Children: A Retrospective Computerized Tomography Scan-Based Study.
Background: Neuraxial techniques provide good postoperative analgesia for painful procedures in the pediatric population. However, any injury to the spinal cord can lead to irreversible long-term effects.
Aims: We aimed to evaluate dura-to-cord (DTC) distance from computerized tomography (CT) images of thoracolumbar spine in pediatric age group (1-16 years) at T8-9, T9-10, and L1-2 interspaces to identify the safe space for epidural insertion in Asian children.
Settings and design: It was a retrospective study including 141 children aged 1-16 years who underwent routine CT scan of the thoracolumbar region for unrelated diagnostic indications.
Materials and methods: Patients with spinal abnormalities were excluded. Sagittal CT images of the thoracolumbar spine were obtained to calculate the DTC at T8-9, T9-10, and L1-2 interspaces. The measurements at all levels were obtained perpendicular to the long axis of the vertebral body.
Statistical analysis used: Continuous data were depicted as mean with standard deviations. The categorical data were presented as counts with percentages.
Results: The mean DTC distance at T8-9, T9-10, and L1-2 interspaces was 3.51 ± 0.98 mm (95% confidence interval [CI]: 3.35-3.67), 2.73 ± 0.94 mm (95% CI: 2.57-2.89), and 2.83 ± 1.08 mm (95% CI: 2.66-3.02), respectively. A significant difference was found between the genders at T9-10 (P = 0.02) and L1-2 levels (P = 0.04). No difference in DTC was found in toddlers, preschool children, school-going children, and adolescents. DTC at T8-9 showed a significant correlation with age (R2 = 0.0479; P = 0.04), weight (R2 = 0.038; P = 0.02), and height (R2 = 0.037; P = 0.03).
Conclusion: Thoracic epidural space can be used in children and adolescents for epidural catheter placement. T8-9 level showed maximum DTC distance and significant correlation with age, height, and weight in CT imaging in the present study.
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