Hey guys,
66M prior uncomplicated L3-4 spinal fusion with 4 level laminectomy 8 months ago now came in for THA. I offered spinal vs GA with emphasis that he has a higher chance of spinal failure and conversion to GA anyway, he agrees to try spinal.
We get into the spinal, I went midline, sitting patient, likely L2-3 ish and got CSF on 1st needle pass with a 25G whitacre, no redirections or anything. He had a brief blood tinge but after that cleared he had persisting yellow CSF. Like, obviously completely yellow, beyond contamination from the needle pass. It also seemed to be under higher pressure than I otherwise would feel from free-flowing CSF. with injecting I could actually see the CSF leaking out around the needle from the introducer needle. Patient reported zero effects from the spinal and we switched to GA.
Not sure how to interpret this, I was reading xanthochromia can be from inflammation and blood present in CSF. This was different from the usual little bit of blood from a needle pass. Anyone have any insights? I'm guessing I wasn't intrathecal because he had no change from the injection, but it really was classic appearing CSF flow and feel beyond 1) higher pressure and 2) yellow-tinged.
66M prior uncomplicated L3-4 spinal fusion with 4 level laminectomy 8 months ago now came in for THA. I offered spinal vs GA with emphasis that he has a higher chance of spinal failure and conversion to GA anyway, he agrees to try spinal.
We get into the spinal, I went midline, sitting patient, likely L2-3 ish and got CSF on 1st needle pass with a 25G whitacre, no redirections or anything. He had a brief blood tinge but after that cleared he had persisting yellow CSF. Like, obviously completely yellow, beyond contamination from the needle pass. It also seemed to be under higher pressure than I otherwise would feel from free-flowing CSF. with injecting I could actually see the CSF leaking out around the needle from the introducer needle. Patient reported zero effects from the spinal and we switched to GA.
Not sure how to interpret this, I was reading xanthochromia can be from inflammation and blood present in CSF. This was different from the usual little bit of blood from a needle pass. Anyone have any insights? I'm guessing I wasn't intrathecal because he had no change from the injection, but it really was classic appearing CSF flow and feel beyond 1) higher pressure and 2) yellow-tinged.
