CESI with OPLL

[Dansk2011]

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Have a patient with radicular symptoms whose MRI shows OPLL at C6/C7 and C7/T1 that is effacing and indenting ventral thecal sac and some cord flattening, but not compression. No mention of severity of central stenosis at those levels and unfortunately I don't have the imaging to review myself. Curious as to how I should approach a CESI...that is if at all. The report doesn't mention T1/T2 either. Appreciate any advice/recommendations?

 

[pmrmd]

It doesn't sound like its anything to be concerned about. If its an old study then repeat it. If its current tell the patient to get the pictures. Go T1-2 if you are anxious.

 

[DOctorJay]

--don't put a needle in someone's neck who you haven't reviewed the images yourself
--OPLL affects the ventral anatomy (as you've noted) and shouldn't really have anything to do with your CESI aside from central canal stenosis (look at images yourself to see if you're safe at C7-T1)
--tell them to lay off the pickles Ossification of the Posterior Longitudinal Ligament: A Review of Literature

 

[lobelsteve]

So why is he having radicular symptoms? Any mention that there is a disk poking onto the nerve. You might want to inject CLR. It is better at treating the underlying pathology of OPLL. Results are immediate and permanent.

 

[Dansk2011]

So why is he having radicular symptoms? Any mention that there is a disk poking onto the nerve. You might want to inject CLR. It is better at treating the underlying pathology of OPLL. Results are immediate and permanent.

He has a few levels of severe neuroforaminal stenosis on the affected side consistent with the referral dermatome. I’ll be honest in that I’m not sure what CLR is...

 

[lobelsteve]

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[Dansk2011]

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[SSdoc33]

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Not the first time household cleaning products have been suggested as a medical treatment recently

 

[SSdoc33]

--don't put a needle in someone's neck who you haven't reviewed the images yourself
--OPLL affects the ventral anatomy (as you've noted) and shouldn't really have anything to do with your CESI aside from central canal stenosis (look at images yourself to see if you're safe at C7-T1)
--tell them to lay off the pickles Ossification of the Posterior Longitudinal Ligament: A Review of Literature

This is the key. Review your anatomy. Your needle isnt going THRU an ossified ligament. That is on the other side of the cord

 

[soccrwz]

I just dont see how CESI will help this unless there are literature to support, sounds like if a pain generator, may need surgical debulking. Cervical spine surgeries, for appropriate indications tend to do better than other surgeries

 

[Dansk2011]

This is the key. Review your anatomy. Your needle isnt going THRU an ossified ligament. That is on the other side of the cord

The concern was in regards to there being possible stenosis at those levels not with the ligament being ossified. Maybe I should have been clearer with my concern/question. I'd love to review my own images but you have no idea how hard it is for me to even get reports for my patients let alone CDs. I work in a very rural area. I try to when I can but when you are dealing with extremely uneducated, older rural folk it's difficult for them to comprehend what the difference is between reports and actual imaging. And unfortunately the small hospitals near by are of no help as even getting a report from them can take weeks to months. It's crazy but it's what I have to work with unfortunately. So the reports are often all I have to go on in order to help them in a timely fashion.

I just dont see how CESI will help this unless there are literature to support, sounds like if a pain generator, may need surgical debulking. Cervical spine surgeries, for appropriate indications tend to do better than other surgeries

CESI for radicular symptoms in setting of neuroforaminal stenosis. Not for OPLL. Treatment has nothing to do with ligament.

 

[lobelsteve]

The concern was in regards to there being possible stenosis at those levels not with the ligament being ossified. Maybe I should have been clearer with my concern/question. I'd love to review my own images but you have no idea how hard it is for me to even get reports for my patients let alone CDs. I work in a very rural area. I try to when I can but when you are dealing with extremely uneducated, older rural folk it's difficult for them to comprehend what the difference is between reports and actual imaging. And unfortunately the small hospitals near by are of no help as even getting a report from them can take weeks to months. It's crazy but it's what I have to work with unfortunately. So the reports are often all I have to go on in order to help them in a timely fashion.



CESI for radicular symptoms in setting of neuroforaminal stenosis. Not for OPLL. Treatment has nothing to do with ligament.

What causes the stenosis directly effects the outcome of treatment.

 

[epidural man]

Tough call without the actual picture to look at.