Ultrasound-guided Thoracic Spinal Level Identification

Study Overview
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Brief Summary
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Typically, the rhomboid minor muscles rise from the C7-T1 spinous process and run downward to touch the upper inner corner of the scapula, and the rhomboid major muscles rise from the T2-T5 spinous process and run downward to reach the lower middle inner corner of the scapula. In anatomical research articles, it has been reported that the rhomboid muscle's anatomical variations are rare. Considering the characteristics of these rhomboid muscles, the investigators planned a study on the utility of rhomboid muscles as a landmark for identifying thoracic spine levels.

Official Title
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Ultrasound-guided Thoracic Spinal Level Identification Using Rhomboid Muscle as a Reference Landmark

Conditions
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Thoracic Diseases, Myofascial Pain

Intervention / Treatment
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* Procedure: Ultrasound imaging & fluoroscopic confirmation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients undergoing thoracic nerve root block due to herpes zoster, postherpetic neuralgia, complex regional pain syndrome, post traumatic pain syndrome, or compression fracture of vertebra. Exclusion Criteria: Previous T-spine surgery Patient refusal Coagulopathy Generalized infection or localized infection at injection site Anatomical abnormality of T-spine Allergic reaction to local anesthetics

Ages Eligible for Study
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Minimum Age: 19 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group 1<br>Ultrasound scanning of the rhomboid muscle | Procedure: Ultrasound imaging & fluoroscopic confirmation<br>* The researchers use ultrasound to scan the left and right sides of the paravertebral sagittal imaging to identify trapezius, semispinalis, erector spinae muscle, transverse process and rhomboid muscle. The radiopaque marker is attached respectively to the skin of the inferior margin of the rhomboid muscle on the left and right thoracic spinal spines. Then, as the first step for the scheduled nerve block to the patient, thoracic vertebra level verification using C-arm is performed. At this time, left and right level of the transverse process of thoracic spine marked with the radiopaque marker are confirmed and recorded.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ultrasound-guided Thoracic Spinal Level | Thoracic vertebra level of radiopaque marker labeled on the rhomboid muscle inferior margin on C-arm | during the procedure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 1. Changes in marker position when raised the arm above the head and in a relaxed position |  | during the procedure | 
| 2. Rhomboid muscle variation | The presence of rhomboid muscle fusion | during the procedure | 
| 3. Visibility grade of muscle fascia using Ultrasound (I - IV) | A. Grade I: Definitely visible B. Grade II: Somewhat visible C. Grade III: Barely visible D. Grade IV: Not visible | during the procedure | 
| 4. Depth: The distance from the skin where the marker is attached to the transverse process of thoracic spine |  | during the procedure | 
| 5. Difference between left and right sides | The distance between left and right inferior thoracic spine attachment site of rhomboid muscle | during the procedure | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Ultrasound guided intervention, Rhomboid muscle, Thoracic spine