Ultrasound Imaging for the Paraspinous Approach to Spinal / Epidural Anesthesia & LPs

A summary of how to use ultrasound imaging of the spine to guide a paraspinous approach to spinal anesthesia, lumbar epidurals, or lumbar puncture. I recommend and practice the preprocedural ultrasound-assisted method in almost all cases. A real-time ultrasound-guided approach is theoretically feasible, but requires advanced skills and is highly challenging to perform when interlaminar spaces are small or hard to visualize.
The PPUSA method described works particularly well if the vertebral canal (anterior complexes) cannot be visualized.