Wait, so you’re doing the whole thing in AP? Going to have to disagree with you there. CLO is much less radiation than lateral, only slightly more than AP, and allows near perfect visualization of the posterior edge of the epidural space.
Maybe comment on your formal training. Most of is have completed residency in Anes or PMR then did a fellowship in Pain (ACGME). Then went to teach and publish.
If you’re doing cervical epidurals with AP fluoroscopy only, then yes. I’m not sure if training does play into it though. I had one faculty member in fellowship, ACGME-trained, who did them AP-only. Terrifying to do them with him. His motto was “inject at the first sign of loss of resistance.” Probably did a lot of interspinous ligament injections. Hadn’t paralyzed anyone as far as I knew.
Perhaps you do a good job. But your posts sound like you are a shot away from paralyzing someone.
The problem with that is when that first change/loss of resistance occurs is intrathecal or in the spinal cord…. That contrast injection won’t save you. There are published case reports of intramedullary/cord injections.
Probably was tickling the cord, which “should” be mostly harmless if just stuck it. If, however, contrast was injected… That causes an iatrogenic syrinx and can be devastating.
where was the burning and numbness located?
Thank you this is what I was looking for. Interestingly, I was at a party last night where I was able to hang out with some of our interventional radiologists soi posed the question to them. They are telling me that this protocol is pretty much useless against true full-blown anaphylactic reactions, which I didn’t realize. Are you guys still using it for those types of patients? Also, he told me he still uses Gad for his spine patients with contrast allergies. He even said they will still do MR myelograms with very low-dose gad which I couldn’t believe.
It would blunt an anaphylactic reaction but they might still need epi. Depends on the severity. Also radiology deals with rapid IV bolus of 10s to 100s of mL of contrast. Someone with an IgE mediated reaction gets that, no amount of Benadryl will protect them.
Gracias
If I can't gently go through, it's caudal for me. I can't remember a time when I was able to punch through heavy calcification.
I’m usually using 25 gauge, so I will sometimes switch to a touhy.
I’ve had to call it a day several times. I just tell the patient and say I’ll keep trying my best to find something that’ll work for you. Patient has never gotten upset and I lost zero sleep that night.
sounds like a fun party. was this discussion before or after keg-stands.
It was at a neurosurgeons place so needless to say the bar and food were top notch
I rarely do a caudal, but even after a 6-12 month hiatus can do it in about 2 minutes. These are consistently easier for me than S1. Outside of hardware shadow and feeling more comfortable using depo rather than dex, I can't think of a reason to do caudals for the reasons you stated.
