CESI in patient with syrinx

[gator2886]

How many of you would do a CESI in a patient with a syrinx of the C-spine at or very near to the location you were planning on doing the epidural? If you elected to do it, under what conditions?

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[willabeast]

How many of you would do a CESI in a patient with a syrinx of the C-spine at or very near to the location you were planning on doing the epidural? If you elected to do it, under what conditions?

how big is the syrinx, what caused it and most important what is the rationale for an ESI?

 

[Taus]

If totally incidental, not myelopathic, and has separate pathology causing radic pain, ie hnp, sure, point n shoot

As long as not myelopathic I’d still suggest non urgent Neuro eval if hasn’t already had one to confirm benign etiology of syrinx

 

[NJPAIN]

If totally incidental, not myelopathic, and has separate pathology causing radic pain, ie hnp, sure, point n shoot

As long as not myelopathic I’d still suggest non urgent Neuro eval if hasn’t already had one to confirm benign etiology of syrinx

Great advice. Most neurosurgeons with get a contrast enhanced MRI to rule out an associated mass. Orthopaedic spine surgeon will do nothing and tell patient it’s not a problem.


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[Dr. Ice]

Most neurosurgeons don’t do anything with these esp if not myelopathic like taus said. They may follow them with repeat imaging every year or two to look to see if expanding. Esi is not a problem in these patients as per neurosurg. It is probably worth it for these patients to establish a relationship with neurosurg early on even if there is no concern and the patient is not myelopathic.

 

[lobelsteve]

Has anyone ever worn a cape? How would anyone know what it feels like to wear a cape?

 

[Baron Samedi]

I wore one for the office Halloween costume contest. I was Dracula. The Cape was nice, kept me warm without restricting my arms but kept getting caught under my rolling chair in the exam room. Overall 8/10 experience, would wear cape again.

 

[emd123]

How many of you would do a CESI in a patient with a syrinx of the C-spine at or very near to the location you were planning on doing the epidural? If you elected to do it, under what conditions?

When I see a syrinx I usually delay any injections and have them see neurosurgery first to have the syrinx worked up. If neurosurg clears them, then it's fine to do injections. As stated above, I've also seen NS typically do an MRI with/without to rule out an ependymoma or other subtle obstruction. Most of these are incidental, or congenital and don't change over time. But I punt to NS and let them conclude that first.

 

[Nonphysiologic]

I have a question related to this. I have a patient who fractured her C Spine 10 years ago and had a decompressive laminectomy C4-C7. She is now partially tetraplegic. She states in the past two months or so she has had LOW BACK pain with shooting pain in her legs which she describes as her "muscles with electic bolts". MRI C Spine is Unchanged from a one 7 years ago but it does have a C6-C7 central syrinx. Her MRI L Spine shows bilateral neuralforaminal narrowing At L4/5 and L5/S1. I'm thinking of just doing a bilateral Transforaminal LUMBAR epidural.

I asked some colleagues about this and they said there is no way they would touch this patient but I can't figure otu why when the syrinx isn't symptomatic and I'd be going transforaminal. Am I missing something?

 

[clubdeac]

I have a question related to this. I have a patient who fractured her C Spine 10 years ago and had a decompressive laminectomy C4-C7. She is now partially tetraplegic. She states in the past two months or so she has had LOW BACK pain with shooting pain in her legs which she describes as her "muscles with electic bolts". MRI C Spine is Unchanged from a one 7 years ago but it does have a C6-C7 central syrinx. Her MRI L Spine shows bilateral neuralforaminal narrowing At L4/5 and L5/S1. I'm thinking of just doing a bilateral Transforaminal LUMBAR epidural.

I asked some colleagues about this and they said there is no way they would touch this patient but I can't figure otu why when the syrinx isn't symptomatic and I'd be going transforaminal. Am I missing something?

Your colleagues are being dramatic. I don't think you have anything to worry about

 

[lobelsteve]

No issue. Squirt it

 

[Brachialis021]

Great advice. Most neurosurgeons with get a contrast enhanced MRI to rule out an associated mass. Orthopaedic spine surgeon will do nothing and tell patient it’s not a problem.


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Sounds like a patient I had on inpatient spinal cord service, who was status post Cervical fusion and had wound dehiscence and we could see bone and were concerned for osteomyelitis. Ortho residents were adamant it was nothing. Eventually we got him to have a bone biopsy with + staph OM