Identifying the lumbar spine on ultrasound

Using ultrasound to help guide your lumbar puncture procedures can be a powerful way to reduce the chances of a failed or traumatic procedure. In this video, you will learn how to identify the lumbar spine and important nearby structures with the help of ultrasound.

Want to perform your own lumbar punctures? Take our Procedural Ultrasound Masterclass course and start using ultrasound to improve the safety of your procedures. Your instructor, Dr Sara Damewood–the Emergency Ultrasound Section Chief and Clinical Ultrasound Fellowship Director at the University of Wisconsin–will guide you through the essentials of procedural ultrasound.

[00:00:00] Before using ultrasound to guide a lumbar puncture, we must discuss the pertinent anatomy of the lumbar spine and how it appears on ultrasound. In the transverse plane, this is what the lumbar vertebral body looks like. You can see the spinous process, lamina, transverse process, and facet. So, here on the right is what this view would look like on ultrasound. The spinous process is the rounded peak,

[00:00:30] with the corresponding shadow. This is important as the spinous process marks the midline of the spine. I find it useful to identify the spinous process first and then rotate to long-axis, to find the next spinous process. Sometimes, we use the low-frequency curvilinear probe to get these views. On this clip, the operator is sliding the probe in the transverse plane. Here you can see the facets, the transverse process as well as the spinous process.

[00:01:00] The spinous process here may appear to you like a steeple. Here, you can see the vertebral body, with its hyperechoic top and corresponding shadow downward. Now, let's take a look at the spine in the sagittal plane. This is a view of a sagittal lumbar spine, with the hyperechoic spinal structures. You can see the paraspinal muscles, which appear striated or striped and the hyperechoic bony

[00:01:30] structures, here, with the corresponding shadowing down. You can see that this view looks the same whether the patient was lying down or sitting up. Great, now you know the sono signature of the lumbar spine.