Ann Rehabil Med.  2016 Aug;40(4):575-582. 10.5535/arm.2016.40.4.575.

Phantom Study of a New Laser-Etched Needle for Improving Visibility During Ultrasonography-Guided Lumbar Medial Branch Access With Novices

• Park JW
• Cheon MW
• Lee MH

• KMID: 2356642
• DOI: http://doi.org/10.5535/arm.2016.40.4.575

Abstract

OBJECTIVE
To compare the visibility and procedural parameters between a standard spinal needle and a new laser-etched needle (LEN) in real-time ultrasonography guided lumbar medial branch access in a phantom of the lumbosacral spine.
METHODS
We conducted a prospective single-blinded observational study at a rehabilitation medicine center. A new model of LEN was manufactured with a standard 22-gauge spinal needle and a laser etching machine. Thirty-two inexperienced polyclinic medical students performed ultrasonography-guided lumbar medial branch access using both a standard spinal needle and a LEN with scanning protocol. The outcomes included needle visibility score, needle elapsed time, first-pass success rate, and number of needle sticks.
RESULTS
The LEN received significantly better visibility scores and shorter needle elapsed time compared to the standard spinal needle. First-pass success rate and the number of needle sticks were not significantly different between needles.
CONCLUSION
A new LEN is expected to offer better visibility and enable inexperienced users to perform an ultrasonography-guided lumbar medial branch block more quickly. However, further study of variables may be necessary for clinical application.

Keyword

Zygapophyseal joint; Ultrasonography; Needles; Radiologic phantoms; Injections

MeSH Terms

Humans
Needles*
Needlestick Injuries
Observational Study
Phantoms, Imaging
Prospective Studies
Rehabilitation
Spine
Students, Medical
Ultrasonography
Zygapophyseal Joint

Figure

• 

  Fig. 1 Computer graphic image of laser-etched needle shows two ultrasound reflectors adjacent to the surface of the needle tip at 2 mm intervals and same-shape ultrasound reflectors located at 5 mm intervals on the same side of the distal needle shaft.

• 

  Fig. 2 Gelatin-Metamucil mixture of the lumbosacral spine phantom. (A) An adult-size lumbosacral spine model. (B) Spinal phantom after the lower layer of gelatin mold has set. (C) Yellowish surface layer of the spinal phantom after the Metamucil-mixed gelatin mold has been added.

• 

  Fig. 3 Ultrasound images of right third lumbar medial branch access with study needles in lumbosacral spine phantom. (A) Using the standard spinal needle. (B) The image of laser-etched needle shows bright dots from the ultrasound reflectors. Open arrowheads, needle shaft; closed arrowheads, needle tip; SP, spinous process; TP, transverse process; IAP, inferior articular process; SAP, superior articular process.

• 

  Fig. 4 Estimates of needle visibility for standard spinal needle (gray bars) and laser-etched needle (black bars).

• 

  Fig. 5 Schematic diagram of ultrasound performance with the inplane approach. (A) Ultrasound beam is reflected off of standard spinal needle surface away from probe. (B) Due to wedge shaped reflectors, part of the ultrasound beam is reflected back to the probe.

• 

  Fig. 6 Ultrasound images of laser-etched needle by location and direction of ultrasound beam (black bar) in soft tissue phantom. Dotted arrows, reflectors of laser-etched needle.

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