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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.22099    [Epub ahead of print]
Published online September 16, 2022.
Three-dimensional pelvis computed tomography-assisted Taylor approach for spinal anesthesia in hip arthroplasty: a retrospective study
Saecheol Oh1, Yoojung Park2, Hana Kwon3, Eunjin Eom3, Dal-ah Kim3
1Department of Anesthesiology and Pain Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
2Department of Anesthesiology and Pain Medicine, Saint Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
3Department of Anesthesiology and Pain Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Corresponding author:  Dal-ah Kim, Tel: 010-9213-2360, Fax: 032-280-5416, 
Email: 20900040@cmcnu.or.kr
Received: 28 February 2022   • Revised: 31 August 2022   • Accepted: 14 September 2022
Abstract
Background
The needle insertion in the Taylor approach of spinal anesthesia is challenging as the L5–S1 space is difficult to locate on surface anatomy. In this study, we wanted to suggest that 3D pelvis CT can assist the anesthesiologist in locating the needle insertion point. By comparing the success rate of 3D pelvis CT assisted-Taylor approach to other approaches in the existing literatures, we would like to report this technique as an alternative method of subarachnoid block in L5-S1 space.
Methods
For this retrospective observational study, we reviewed the records of hip arthroplasty using the 3D pelvis CT-assisted Taylor approach. The virtual two-dimensional plane was created with a midline and intercristal line on the posterior view of the 3D pelvis CT. Another imaginary guidance line was created from the crossing point of the two lines to the ideal skin insertion point of Taylor approach. The primary outcome was the success rate. Secondary outcomes are the angle between the intercristal line and the guidance line, the length of the guidance line and the distance from the ideal needle insertion point to the L5-S1 space within the midline.
Results
We reviewed the records of the 276 patients who underwent hip arthroplasty using 3D CT-assisted Taylor approach. From the 276 patients only 25 patients had been failed with the 3D CT- assisted Taylor approach in L5-S1 subarachnoid block. The success rate of 3D CT-assisted Taylor approach was 90.9%. The needle insertion point was identified with the results of measurement from the pelvis 3D-CT, 5.9±0.6cm on a line 65.5±5.8o off the intercristal line. The target of L5-S1 space intended to be displayed on the skin was 2.7±0.6cm away from the needle insertion point. Moreover, the number of spinal deformities was not related to the success rate.
Conclusions
A 3D pelvis CT-assisted Taylor approach of spinal anesthesia can be an alternative method of subarachnoid block in L5-S1 space with the acceptable success rate.
Key Words: Anesthesiologists; CT; Femoral neck fractures; Hip arthroplasty; Men; Pelvis; Spinal anesthesia; Women
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