This diagnostic image displays dual-pane intraoperative C-arm fluoroscopy views (anteroposterior and lateral) of the lumbar spine during a minimally invasive spinal procedure. The images demonstrate the precise positioning of a radiofrequency (RF) puncture needle within an intervertebral disc space. In the anteroposterior (AP) view on the left, the needle tip is centered over the disc, with contrast medium appearing as a dark, radiopaque area spreading horizontally within the nucleus pulposus and toward the annulus fibrosus. The lateral view on the right confirms the depth of the needle tip within the center of the disc space, showing the longitudinal distribution of the contrast agent along the superior and inferior vertebral endplates. These images are clinically significant for verifying needle placement and contrast spread during intradiscal radiofrequency thermocoagulation or discography for the treatment of lumbar disc herniation. The modality is fluoroscopic guided intervention, highlighting anatomical landmarks including vertebral bodies, pedicles, and the intervertebral disc interval.

This clinical photograph depicts a simulated infant lumbar puncture procedure performed in a medical skills laboratory setting. The image shows a medical trainee wearing white sterile gloves and a mask, positioned to insert a yellow-hubbed spinal needle into the lower back of an infant mannequin. The mannequin is placed in a lateral decubitus (side-lying) position on a blue surgical drape, with an assistant's hands visible stabilizing the upper torso and limbs to maintain the necessary spinal flexion. Surrounding the procedural field are various medical supplies, including a kidney dish containing sterile gauze and swabs, and organized containers with sample vials or additional equipment. The focus of the visual is on the anatomical landmarks of the lumbar spine and the correct hand positioning for needle insertion. This educational material is designed to demonstrate paediatric procedural skills, aseptic technique, and proper patient positioning for cerebrospinal fluid collection or diagnostic testing in neonatal and paediatric medicine.

An axial non-contrast CT scan of the abdomen and lower lumbar region, demonstrating a CT-guided interventional procedure. The image shows a spinal needle traversing the paraspinal musculature and subcutaneous fat from a left-sided approach. The needle tip is precisely positioned within the spinal canal, targeted for an intrathecal injection (nusinersen) in a patient with Spinal Muscular Atrophy (SMA). The spinal anatomy displays significant rotation and distortion consistent with severe scoliosis. Visible internal landmarks include a vertebral body, the spleen in the right aspect of the image (due to patient positioning), and loops of bowel with speckled fecal content. The image illustrates the standard protocol for neuraxial access in complex anatomical scenarios where traditional palpation-based lumbar puncture is not feasible due to skeletal deformities. Key features include the visualization of the needle trajectory, the clear identification of the target intrathecal space, and the surrounding soft tissue and osseous structures.

**Imaging Modality:** Intra-operative fluoroscopy (spot film). **Anatomical Region:** Lateral view of the lumbar spine, specifically focusing on the lower lumbar vertebrae and the sacral promontory. **Procedure and Findings:** The image demonstrates a fluoroscopically guided needle placement for a spinal procedure. A radiopaque spinal needle is visible, transversing the soft tissues and terminating within the spinal canal. Intrathecal administration of water-soluble contrast media is evidenced by a distinct, vertical column of radiopacity flowing within the subarachnoid space (myelographic effect). The contrast is seen layering anteriorly and inferiorly along the spinal canal, highlighting the borders of the dural sac. **Key Visual Features:** - **Needle Position:** Lateral approach with the tip localized to the posterior aspect of the vertebral canal. - **Contrast Pattern:** Sharp, linear opacification characteristic of intrathecal (subarachnoid) distribution, rather than the "feathery" or "vacuolated" appearance typical of epidural injection. - **Landmarks:** Lumbar vertebral bodies, intervertebral disc spaces, and the spinous processes are partially visualized. **Clinical Significance:** This image serves as confirmation of needle tip positioning within the intrathecal space during a myelogram, lumbar puncture, or spinal anesthesia procedure.

This diagnostic fluoroscopic image set illustrates a lumbar intersomatic disc puncture procedure using a 22G needle, commonly performed for intradiscal injections such as oxygen-ozone (O2-O3) therapy. Image A presents a lateral view of the lumbar spine, demonstrating the needle's trajectory from a posterior-lateral entry point. The needle tip is clearly visualized penetrating the intervertebral disc space between two lumbar vertebrae, positioned centrally within the disc. Image B shows the frontal (anteroposterior) view of the same procedure, highlighting the needle traversing toward the radiolucent gap representing the disc space. The stacked vertebral bodies and their respective endplates serve as critical anatomical landmarks for verifying correct needle placement. Of note, radiopaque vascular stents are visible in the foreground, indicating the patient's comorbidities. This visual serves as an educational guide for image-guided spinal interventions, focusing on the transforaminal or lateral approach to the nucleus pulposus for treating chronic low back pain or disc herniation.

Diagnostic CT scout images (sagittal and dorsal views) demonstrating the procedural localization for a lumbar puncture in a porcine model. The sagittal view (left) shows a 22-gauge, 1-inch guide needle inserted as a radiopaque cutaneous marker. Its placement is localized dorsally between the L3 and L4 lumbar vertebrae, utilizing the cranial border of the flexed stifle as a palpable anatomical landmark. The dorsal view (right) displays the final positioning of the larger spinal needle in relation to the guide needle. Both needles are visible as linear radiopaque densities along the dorsal midline. The spinal needle is positioned cranially to the guide needle, precisely targeting the L3-L4 intervertebral space for subarachnoid access. These views are essential for confirming the longitudinal and midline trajectory before advancing the needle to the floor of the vertebral canal for myelographic contrast injection. Key anatomical landmarks labeled include the L3, L4, and L5 vertebrae and the flexed stifle joint.

This medical anatomical diagram illustrates the layers of the human meninges and the organization of the subarachnoid space. The lower panel displays a sagittal view of the head, identifying internal structures such as the lateral, third, and fourth ventricles, alongside circumventricular organs including the pineal gland and posterior pituitary. The upper panel provides a high-magnification cross-sectional view of the cranial protective layers. From superficial to deep, it depicts the skull, the dura mater (consisting of periosteal and meningeal layers containing lymphatic vessels), the arachnoid mater, and the subarachnoid space filled with cerebrospinal fluid (CSF). The arachnoid trabeculae are shown spanning the subarachnoid space to connect with the pia mater. Below the pia mater, the glia limitans is illustrated, formed by astrocytic foot processes that interface with the underlying brain parenchyma and cortical blood vessels. This diagram is designed to explain leptomeningeal anatomy and the fluid dynamics between the ventricular system, subarachnoid space, and the blood-brain barrier interface.

This composite educational material consists of an anatomical diagram (A) and a corresponding intraoperative clinical photograph (B) illustrating the surgical approach to the preperitoneal space during hernia repair. Diagram A provides a sagittal cross-section of the abdominal wall layers, including the skin, rectus abdominis, posterior rectus sheath, transversalis fascia, and peritoneum, highlighting the entry pathway into the Retzius space above the bladder and pubic bone. Intraoperative image B shows the laparoscopic view of the 'first incision point' within the transversalis fascia, located approximately 1 cm above the pectineal ligament (Cooper's ligament). The Retzius space is visible as a cavitary area with glistening, translucent connective tissue and fibrous networks. The pectineal ligament is identified as a distinct whitish band at the superior margin. This visual material is designed for surgical trainees to understand the 'transversalis fascia reference plane' and membrane anatomy during Totally Extraperitoneal (TEP) laparoscopic hernia repair, emphasizing safe entry into the Retzius space to avoid vascular or bladder injury.

This diagnostic ultrasound image demonstrates spinal anatomy in a transverse view, likely used for neuraxial anesthesia planning or a lumbar puncture. The image features two key anatomical landmarks: the posterior complex (marked by a white arrowhead), which consists of the ligamentum flavum, the epidural space, and the posterior dura mater; and the anterior complex (marked by a white arrow), representing the posterior longitudinal ligament and the vertebral body. The posterior complex appears as a layered, hyperechoic structure superior to the intrathecal space. A vertical yellow caliper line with blue dots extends from the skin surface to the posterior complex, measuring the skin-to-ligamentum flavum distance, which is critical for determining appropriate needle depth. The ultrasound shows typical tissue echogenicity variations, with subcutaneous fat and muscle layers visible superficial to the spinal structures. This visual is an essential educational tool for understanding ultrasound-guided identification of the epidural and subarachnoid spaces.

A clinical photograph depicting a patient's lower back prepared for a neuraxial procedure, likely a spinal anesthesia or lumbar puncture. The patient is draped in blue sterile material with a central rectangular exposure of the skin. Two black horizontal line markers are visible on the skin, labeled 'midline' and 'paramedian' to distinguish between different technical approaches to the subarachnoid space. A medical professional, wearing sterile white gloves, is shown inserting a spinal needle through the skin. The needle features an orange-coded hub, typically indicating a 25-gauge needle diameter. The needle is being advanced at the point corresponding to the 'paramedian' marker, demonstrating the lateral entry technique which bypasses the supraspinous and interspinous ligaments to access the spinal canal. This image serves as an educational resource for anesthesiology and neurology trainees to understand surface anatomy and procedural needle placement for spinal blocks.