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NEW ARTICLE PUBLISHED IN JOURNAL "Ultrasound and functional diagnostics"

 

In the journal "Ultrasound and functional diagnostics" №2, 2015 published an article "Spine Ultrasound and Lumbar Puncture in Clinical Practice (Short History)": Y.N. Bogin, I.D. Stulin, N.A. Shapiro, L.A. Suvorova.

Short history of spine ultrasound and use of ultrasound guided lumbar puncture in clinical practice are presented in the article. It is shown priority of Russian scientists in method invention. First study (Application of the method of two-dimensional echospondylography for determining landmarks in lumbar punctures) was published in 1971 in Russia. Ultrasound guided lumbar puncture plays important role in treatment and diagnostic manipulations.
     

  In 1971 in the “magazine of neuropathology and psychiatrics called after S. S. Korsakov” (book LXXI, the addition 12, p. 1810 – 1811) [1], for the very first time was published the work devoted to the diametric ultrasonic research of the axis (echospondiography) for the directions’ identification during the procedure  called the lumbar puncture. A simple method of research was presented in the work and this method was secure for the patients. It allowed to identify and mark exactly the internal bone cavity during the lumbar puncture and realized many other procedures. The research was conducted for the patients using the native machines UZD-4 and UZD-5 with the help of two-dimensional sensor with the water break in the sitting and the laying positions on the left side.

        The working area of the ultrasonic transducer was compactly fixed in the axis midline in the zone LI-LV so its interior-posterior axis was matched together with the line that was connected with the acanthi.

           On the echograms that were got as a result the boundaries of acanthas’ were well defined (X) and the interspineous space (Y). Then the specially made metal strip was fixed between the patient’s skin and the working area of the sensor (perpendicularly from the interior-posterior axis of the sensor) and it was moving until the reflecting of the metal strip stopped on the level of interspeneous space. Right in that place the contrast line marked the spot on the skin for the puncture.

          The procedure was tested for the patients who had the constitutional and abnormal changes in the axis area. There was made the puncture on the marked spot and the results were successful from the first attempt in 88%. They have the cerebrospinal fluid from all patients for the diagnostic cytological research.

         In the previous years, the cerebrospinal fluid research that was included the cytological methods have been using rather often than nowadays because of the absence of the radial diagnostic methods (CT, MRE). Because of the contemporary instrumental methods of diagnostics, the necessity of the lumbar puncture procedure was rather reduced but it is still necessary in researches of meningitis signs, autopathic assiduous headaches, inflectional and herpetic processes, ear nose throat illnesses in a difficult forms. Etc.

         Besides of absolute assessment of etiology of central nervous system damage in a many statements (a bit subarachnoid hemorrhaging, hydro meningitis and other) the lumbar puncture not only mark the diagnose but also reduce the headache dramatically if there is a syndrome of intracranial hypertension.

          The authors think that the method developed by them is simple, accessible and painful. The method of the axis ultrasonic research can be extremely useful in the clinical medicine not only for experienced specialists but also for the beginner doctors.

          The foreign specialists (R. C. Cork et al., 1980) [2] 9 years later after the publication of the first work by Y. N. Bogin, I. D. Stulin (1971)[1] started actively involve the axis ultrasonic research into the clinical medicine, using the technique that have been developed earlier.

          T. Grau et al, (2001-2004) [3-13] generalized the researches that were demonstrated the ultrasound usage in the epidural analgesia and in this way they confirmed the importance of the ultrasonography for the valuation of axis structures.

          R. M. Ferre, T. W. Sweeney (2007) [14] confirm that this method allows to get the orienteers of the lumbar puncture quickly (in 87, 9 % during 1 minute, in other cases – less than five minutes).

          K. J. Chin et al. (2010) [15] in a great research, based on the detailed studying of 84 sources, discussed the basic anatomical principals and the ultrasonic anatomy of back bone on the chest and dorsolumbar levels for adults and also offered the system principal for the ultrasonic visualization of the axis during the spinal and epidural anesthesia. These authors also valued the peculiarities of the ultrasound for the neuraxial blockades right on that period of the method’s development. There have been made an important remark about that method. If there are neighbor lumbar vertebrae of acoustic window between the bodies,the ultrasonic wave penetrates into the structure inside of the spinal canal. This window always may be used for the needle to the epidural and intrathecal space.

          In a big practical book by A. Levitov  et al. “Bedside Ultrasonography in Clinical Medicine” (2011) [16] the whole chapter (chapter 18) is devoted to the general puncture procedures under the control of ultrasound. In the chapter, “The Lumbar punctures” the authors refer to the basic work published in 1971.

          During the last years the quantity of the works devoted to the spinal channel’s ultrasonic research usage is not reduce, there are being discussed different aspects of the issue. M. Mofidi et al. (2013) [17] pay attention not only to the quickness of the procedure but also on the rather less quantity of sequallaes during the puncture under the control of ultrasound comparing with the traditional spinal puncture.

          Tirado et al. (2013) [18] pay special attention not only to the medical aspects of the issue but also study the diagnostic opportunities of the method of puncture under the control of ultrasound in details , underlining that during this method’s using when there is the opportunity to follow after the needle contour the accuracy of needle’s introducing  is being increased and the quantity of mistakes is being reduce at the same time.

           At least in the history of American anesthetic society (2013) [19] in the chapter about the using of anesthesiology under the control of ultrasound it is said about the Russian priority in this method’s creation.

           In summary nowadays, it has recognized that the ultrasonic control that was started with the moment of this method’s creation by us made a real revolution in the regional anesthesia. This control is extremely important and necessary in the neuroanesthesia and the spinal neurosurgery and lots of publications and monographs prove that fact. We could continue to specify the researches and works based on that issue but the principals described higher are still permanent.

            In other words if we look to this issue in a more wide way we can see that the lumbar puncture under the control of ultrasound plays a very important role in the medical (the regional anesthesia, the dedication of any medicine into the spinal canal) procedures.

            In spite of that, the role of this method does not exhaust.

            Unfortunately not so much attention have been considered to the diagnostic aspects of this issue in the literature for example the aspect of the material’s getting for the cytological research in the case of blastoma and many other illnesses of the central nervous system. Quick and painful getting of the cerebrospinal fluid for the urgent cytological research of that fluid very often and economically solve the problem of the diagnose assessment after the patient’s first visit to the clinic. If this method is not used, the patient have to be under the hard and difficult diagnostic research during several weeks. We hope that the proved effectiveness of the using of the axis ultrasonography in the case of the lumbar punctures by specialists will stimulate its adaptation into the wide medical practice.

 

LITERATURE
1. Bogin Y. N., Stulin I. D. About the usage of the method of diametric echospondilography for the points’ identification during the procedure of the lumbar puncture// magazine of neuropathology and psychiatrics called after S. S. Korsakov. 1971. LXXI, the addition 12, p. 1810 – 1811.
2. Cork R. C.., Kryk J. J., Vaughan R. W. Ultrasonic localization of the lumbar epidural space // Anesthesiology. 1980. V. 52. No.6. P. 513-516.
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