A 63-year-old male patient with a history of diabetes, hypertension, heart disease, and spinal injury 12 years prior requiring instrumentation and fusion at L1 was undergoing a total hip replacement. Due to his short, fat neck and barrel chest, the patient's lumbar spine landmarks could not be palpated, necessitating the use of neuroaxial ultrasound to identify the intervertebral spaces and guide epidural anesthesia for the hip replacement surgery. Neuroaxial ultrasound provides several views of the spine that can help locate anatomical structures when palpation is difficult.

1. Neuroaxial ultrasound

2. When we need it ?
63ys old male patient , known DM ,
HTN , IHD with H/o 2ys DES on aspirin,
RA ......THR
H/o of spinal injury12 ys with burst
#l1 withn instrumentation and fusion.
HT 1.7 m...BMI 35.... Short fat neck and
barrel chest.
Lumbar scar with no palpable
landmarks....

10. parasagittal transverse view

11. Parasagittal articular
process view

12. Parasagittal oblique view

13. Transverse spinous view

14. Transverse interlaminar view

15. Paramedian describtion of
Kim chin and chan