Cervical epidural in Chiari malformation patients

[smarterchild]

Hi all. Looking for some advice and education. I have a 65 year old patient who came to me with a cervical radiculopathy. Pcp ordered the cervical mri, which showed herniated disc and compression of c5 nerve root. A chiari type 1 malformation was incidentally found and patient has never had any symptoms. No syrinx seen.

What are your thoughts on performing cervical epidurals on these patients? I was under the impression to avoid them given potential risk for herniation.

Does the presence of a syrinx change anything?

Would the same apply if this patient came in for a lumbar epidural?

Thanks

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[SSdoc33]

Hi all. Looking for some advice and education. I have a 65 year old patient who came to me with a cervical radiculopathy. Pcp ordered the cervical mri, which showed herniated disc and compression of c5 nerve root. A chiari type 1 malformation was incidentally found and patient has never had any symptoms. No syrinx seen.

What are your thoughts on performing cervical epidurals on these patients? I was under the impression to avoid them given potential risk for herniation.

Does the presence of a syrinx change anything?

Would the same apply if this patient came in for a lumbar epidural?

Thanks

No. Just do the shot. No problems

 

[Orin]

No. Just do the shot. No problems

Agreed.

Next question:
Interlaminar at C7/T1, Interlaminar at C7/T1 with catheter, interlaminar at C5/C6, or a TFESI

Assume dexamethasone for all?

 

[SSdoc33]

Agreed.

Next question:
Interlaminar at C7/T1, Interlaminar at C7/T1 with catheter, interlaminar at C5/C6, or a TFESI

Assume dexamethasone for all?

Start with c7-t1 interlam without catheter.

That should be enough. Ill send for a CTFESI once every 2 years or so

 

[SommeRiver]

Agreed.

Next question:
Interlaminar at C7/T1, Interlaminar at C7/T1 with catheter, interlaminar at C5/C6, or a TFESI

Assume dexamethasone for all?

ILESI at C5-6?

Nah...

 

[smarterchild]

Thanks all! I was thinking of a c7-t1 ilesi

 

[deleted131481]

Agree with the above. I learned in training to do CESI at C6-C7 without a catheter or C7-T1 with a catheter. Switched to C7-T1 after spending some time on this forum and feel it is much safer/simpler. I still use depomedrol for cervical ILESI but may switch to dexamethasone.

Regarding asymptomatic Chiari I and epidurals, the OB anesthesia literature overwhelming supports use of neuraxial anesthesia for these patients. Cervical is probably even safer regarding theoretical risk of herniation.