Cervical epidural in Chiari malformation patients

Jun 28, 2006
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  1. Pre-Medical
    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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    1. Attending Physician
      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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        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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