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Cervical epidural in Chiari malformation patients

smarterchild

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Jun 28, 2006
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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
 

SSdoc33

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Apr 23, 2007
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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
 
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ragnathor

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Jan 10, 2007
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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.
 
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