The use of ultrasound to facilitate spinal anesthesia in a patient with previous lumbar laminectomy and fusion: A case report

We describe a case of ultrasound (US)‐facilitated spinal anesthesia in a patient with a prior lumbar laminectomy and spinal fusion who presented for total knee arthroplasty. Traditional, landmark‐guided spinal anesthesia had previously failed. Although pre‐procedural US identified a soft‐tissue window at L3/4, a 25G pencilpoint needle encountered resistance. Reassured from US imaging that this was not bone, we used a 22G cutting tip needle successfully. We believe spinal anesthesia would not have been possible in this patient without US, adding to the evidence that US‐facilitated neuraxial anesthesia is useful, particularly in technically difficult, if not ‘impossible,’ cases. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009