case_images: PMC10077796_01
case_images: Sitting position
case_images: SJA-17-110-g001.jpg
case_images: PMC10077796_01_SJA-17-110-g001.jpg
case_images: F1
case_images: After entering the operating room, a sitting position was assumed by her [Figure 1].
case_images: Marking site of the middle line and the 3rd to 5th spinous process
case_images: SJA-17-110-g002.jpg
case_images: PMC10077796_01_SJA-17-110-g002.jpg
case_images: F2
case_images: Sacrum and the 3rd to 5th lumbar spinous process were detected with ultrasound convex probe (SONIMAGE HS2, KONICA MINOLTA) and the middle line and spinous process were marked [Figure 2].
case_images: Sagittal view of the lumber spinous processes. The distance between skin and spinous process is getting larger along caudal side. This was taken later with the cooperation of the patient. L3; the 3rd lumber spine, L4; the 4th lumber spine, L5; the 5th lumber spine
case_images: SJA-17-110-g003.jpg
case_images: PMC10077796_01_SJA-17-110-g003.jpg
case_images: F3
case_images: After several times of trials, we used ultrasound again and identified the space between lumbar spinous process and lumbar subcutaneous tissue getting thicker caudally in the sagittal view [Figure 3].
case_images: This figure shows the distance between lamber vertebra and skin is getting larger as it goes. Dotted arrow is the puncture of the first trial and double line arrow is the puncture of the second trial
case_images: SJA-17-110-g004.jpg
case_images: PMC10077796_01_SJA-17-110-g004.jpg
case_images: F4
case_images: We adjusted puncture angle toward the cephalic side [From dotted arrow to double line arrow in Figure 4].