CESI reviewing epidural space

[schmee90]

---

Members do not see this ad.

How much is adequate space before you say this level doest have enough epidural space for a cervical interlaminar? I am pretty conservative and dont go abotu C7-T1. I have had a few patients with no compressive disc pathology but just not much epidural space on MRI(wondering how ofter others see this). Pathology is at C4-5 so really dont want to go to T1-2, but also dont want a wet tap or worse. As always thank you in advance.

 

[RoloTomassi]

I don't check for fat. It's a potential space

 

[MD87]

Assessment of epidural fat at C7-T1 with image review prior to cervical interlaminar epidural steroid injections

In 2015, the Multidisciplinary Pain Workgroup suggested that cervical interlaminar epidural steroid injections should “be performed at C7–T1, but preferabl

academic.oup.com

 

[schmee90]

Assessment of epidural fat at C7-T1 with image review prior to cervical interlaminar epidural steroid injections

In 2015, the Multidisciplinary Pain Workgroup suggested that cervical interlaminar epidural steroid injections should “be performed at C7–T1, but preferabl

academic.oup.com

Could you repost please, link doesnt work

 

[stsa84]

Link is broken

 

[schmee90]

I don't check for fat. It's a potential space

I don't check for fat. It's a potential space

Understood that this is a potential space but epidural fat is most abundant component in the posterior epidural space... this and a few other articles are what I have gone off for looking for epdirual space size . Would love it if you have any more articles or info on how you look approximate the posterior epidural size for CESI.

Also that being said is there a point were you say there is not enouth space. The tiny article I referenced says"no cervical ILESI should be undertaken, at any segmental level, without reviewing, before the procedure, prior imaging studiesthat show there is adequate epidural space for needleplacement at the target level” [2]. However, it did notprovide further guidance regarding specific imaging mo-dalities or findings."

Thus would love to see if more experiened docs have more info or references on better ways to measure epdirual space beyone fat, and ur cut off for there is not enough space for a CESI im not going to do this injection or I will do a different level.

Cervical Posterior Epidural Space on T1- vs T2-Weighted MRI

Cervical interlaminar (IL) epidural steroid injections (ESIs) are common in clinical practice, but a known risk is spinal cord injury [1]. The Multi-Societ

academic.oup.com

 

[$hadow]

Link is broken

Could you repost please, link doesnt work

Assessment of epidural fat at C7-T1 with image review prior to cervical interlaminar epidural steroid injections

In 2015, the Multidisciplinary Pain Workgroup suggested that cervical interlaminar epidural steroid injections should “be performed at C7–T1, but preferabl

academic.oup.com

 

[stsa84]

I check T1 axial. If there's a sliver of white at C7-T1 I'll attempt there, with plan to move down to T1-2 if things seem less than straightforward.

 

[schmee90]

Thanks for the article..and the input...sliver of white is kind of what ive been saying too lol wondering if there was more info.

 

[Dansk2011]

I check T1 axial. If there's a sliver of white at C7-T1 I'll attempt there, with plan to move down to T1-2 if things seem less than straightforward.

Can usually get a good idea on T1 sag too. But yeah agreed.

 

[Joosbocks]

I don't check for fat. It's a potential space

I don't agree with this. Sure, the areas above C6-7 are usually a potential space but C7-T1, 90+% of the time, has visible epidural fat on a T1 sagittal. That makes it a real space.

My rule of thumb is to not put a needle where I don't at least see some epidural fat.

 

[RoloTomassi]

I don't agree with this. Sure, the areas above C6-7 are usually a potential space but C7-T1, 90+% of the time, has visible epidural fat on a T1 sagittal. That makes it a real space.

My rule of thumb is to not put a needle where I don't at least see some epidural fat.

I'm saying at the minimum it's still a space and I would inject if I didn't see fat but if you're more cautious that's fine too

 

[Gnarvin]

If you look at the axial slices and really think about it, the amount of fat is usually like a square millimeter and almost always dead midline. I don’t think most of us access dead midline, and even if we wanted to, I don’t think we could hit that mm square target every time. I think we really are accessing a potential space the majority of the time for cervical epidurals. Kind of crazy to really think about.