게시판
| 21KS-034 |
Ultrasound-guided identification of the rhomboid muscle as a reference landmark
Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine
Background
This study was conducted to investigate whether the inferior margin of the rhomboid major muscle could be used as a landmark to confirm the mid-thoracic vertebral level.
Materials and methods
100 adults (18-85 years) patients undergoing cervical or thoracic procedure under fluoroscopy guidance were included in this prospective observational study. After laying the patient on a radiolucent table in prone position, we placed a high-resolution linear probe at medial border of scapula. The inferior margin of rhomboid was identified at the plane of the lateral margin of transverse process, and the radiopaque marker was placed on both sides. Vertebral level check was performed through fluoroscope at the anteroposterior view.
Results
As the thoracic level of Rhomboid muscle end at the transverse process, T6 was the most common in both postures and left and right, followed by T5, T7, and rarely T4 and T8. In the prone position with both arms raised, T6 was observed at 59.0% on the left and 57.0% on the right, respectively. In the prone position with both arms down, T6 was found to be 55.0% on both the left and right sides. There was no change in the level difference according to the posture change in 73% of the left and 70% of the right.
Conclusion
The inferior margin at the transverse process level of the rhomboid major muscle could be helpful in discriminating the mid-thoracic vertebral level in various ultrasound procedures.
Reference
1. Heo, J.-Y., et al., The validation of ultrasound-guided target segment identification in thoracic spine as confirmed by fluoroscopy. Clinics in Orthopedic Surgery, 2017. 9(4): p. 472-479.
2. Marhofer, P., et al., Lateral ultrasound-guided paravertebral blockade: an anatomical-based description of a new technique. British journal of anaesthesia, 2010. 105(4): p. 526-532.
This study was conducted to investigate whether the inferior margin of the rhomboid major muscle could be used as a landmark to confirm the mid-thoracic vertebral level.
Materials and methods
100 adults (18-85 years) patients undergoing cervical or thoracic procedure under fluoroscopy guidance were included in this prospective observational study. After laying the patient on a radiolucent table in prone position, we placed a high-resolution linear probe at medial border of scapula. The inferior margin of rhomboid was identified at the plane of the lateral margin of transverse process, and the radiopaque marker was placed on both sides. Vertebral level check was performed through fluoroscope at the anteroposterior view.
Results
As the thoracic level of Rhomboid muscle end at the transverse process, T6 was the most common in both postures and left and right, followed by T5, T7, and rarely T4 and T8. In the prone position with both arms raised, T6 was observed at 59.0% on the left and 57.0% on the right, respectively. In the prone position with both arms down, T6 was found to be 55.0% on both the left and right sides. There was no change in the level difference according to the posture change in 73% of the left and 70% of the right.
Conclusion
The inferior margin at the transverse process level of the rhomboid major muscle could be helpful in discriminating the mid-thoracic vertebral level in various ultrasound procedures.
Reference
1. Heo, J.-Y., et al., The validation of ultrasound-guided target segment identification in thoracic spine as confirmed by fluoroscopy. Clinics in Orthopedic Surgery, 2017. 9(4): p. 472-479.
2. Marhofer, P., et al., Lateral ultrasound-guided paravertebral blockade: an anatomical-based description of a new technique. British journal of anaesthesia, 2010. 105(4): p. 526-532.
