Ultrasonography of the lumbar spine: Sonoanatomy and practical applications |
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Affiliation: | 1. Service de rhumatologie, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex, France;2. Service de neurotraumatologie, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex, France;1. Service de Médecine Interne, CHU Hôtel-Dieu, Nantes, France;2. Department of Medicine, Respiratory Division, McGill University Health Center, Montréal, Québec, Canada;3. Service de Pneumologie, CHU Guillaume-et-René-Laennec, Nantes, France;4. Department of Medicine, Division of Rheumatology, McGill University Health Center, Montréal, Québec, Canada;1. Cellular Inflammation and Cartilage Research Group, IMIM (Hospital del Mar Research Institute), C/Dr. Aigüader 88, 08003 Barcelona, Spain;2. Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada;3. Institute of Human Development, University of Manchester and Manchester Royal Eye Hospital and Centre for Advanced Discovery and Experimental Therapeutics, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom;4. Department of Surgery, McGill University, Genetics Unit, Shriners Hospital for Children, Montreal, Quebec, Canada;5. Department of Rheumatology, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain |
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Abstract: | Ultrasonography of the bones and joints has gained considerable ground in the field of rheumatology over the past decade and is now used in everyday practice both for diagnostic purposes and to guide local injections. However, the use of ultrasonography is virtually confined to the peripheral joints, whereas spinal diseases make a major contribution to rheumatology practice. Studies have established that ultrasonography of the lumbar spine is feasible. Adequate equipment and familiarity with spinal sonoanatomy are required. In this update, we suggest starting with a systematic examination of the lumbar spine to assess the various anatomic structures, from the thoracolumbar fascia superficially to the posterior part of the vertebras at the deepest level. The ligaments, erector spinae muscles, facet joints, and transverse processes can be visualized. Ultrasonography can serve to guide injections into the facet joints, about the nerve roots, and into the iliolumbar ligaments; as well as to identify relevant landmarks before epidural injection. Although diagnostic applications are more limited at present, systematic studies of abnormal ultrasonography findings will allow evaluations of the potential usefulness of ultrasonography for diagnosing spinal disorders. The depth of the spinal structures limits the ability to obtain high-resolution images. However, future technical improvements in ultrasound transducers and machines, together with the growing number of physicians trained in ultrasonography, can be expected to benefit the development of spinal ultrasonography in the near future. |
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Keywords: | Ultrasonography Lumbar spine Ultrasound-guided injection Facet joints Epidural injections Iliolumbar ligament |
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