tried plastic LOR, not used to it, trained with glass since anesthesia days. I like to advance the needle with both hands, then tap for LOR, instead of advancing with one hand and pushing down on the plastic syringe plunger.ICesi - hanging drop
ILesi - prefer plastic, but why don't u just do a 4-5 lvl lumbar TFESI instead?
I was trained with plastic, and probably am skewed towards that, tried the glass, just isn't my style. Sorry to derail the topic.
.tried plastic LOR, not used to it, trained with glass since anesthesia days. I like to advance the needle with both hands, then tap for LOR, instead of advancing with one hand and pushing down on the plastic syringe plunger.
doing IESI for cervical with LOR and lumbar, mostly for central canal stenosis. Shall I explain to you why or direct the discussion to hanging drop on cervical IESI
Not to be personal but wtf? Have done. Not the best technique. Try clo with saline(i do saline and air as like feel) I am a big fan of learning different techniques and watch the hub of the needle for a small fluid column drop once past ligament prior to lor. Similar to the meniscus drop. Just a hint though. Often times i just use a modified lor with contrast nowICesi - hanging drop
ILesi - .
Nah, just throwing it out there, partially facetious. Lol. I'm a fan of trying new techniques, but ultimately, I use LOR plastic.Not to be personal but wtf? Have done. Not the best technique. Try clo with saline(i do saline and air as like feel) I am a big fan of learning different techniques and watch the hub of the needle for a small fluid column drop once past ligament prior to lor. Similar to the meniscus drop. Just a hint though. Often times i just use a modified lor with contrast now
I swtiched from glass in fellowship to a 5cc regular plastic based on this forum and havent looked back. though my contrast syringe is 3cc
How far are you advancing your 25 ga needle prior to starting to inject contrast? I'm still using an 18 ga Hustead but I am not using LOR but rather injecting contrast attached via a short extension tube. I start injecting contrast when I am 3/4 the way between the posterior edge of the lamina and the anterior laminar line. At times there is great resistance to injection and I have a great LOR and linear contrast pattern when I reach the anterior laminar line. However, frequently there is little resistance to injection and contrast starts spilling along the multifidi. I'm thinking that perhaps I should be advancing further before starting the contrast injection.Whats LOR? 25g CLO. Direct visualization with contrast before and after ligament. Hanging drop, so 70s.
I use plastic with air for scs cases. 14g really has more feel.
How do you know whether the glass syringe is autoclave-able? The packaging I have for the glass LOR doesn't say single-use only. What will happen if it's single-use and it's autoclaved?
Bigger needles make LOR more pronounced. Typically the loss of drag on a 14g tells you are in the epidural space.when I do SCS I don't bother with LOR at all, I just use the guidewire since LOR is not reliable with 14G needle.
when you use contrast instead of LOR to test for epidural space, do you look on the lateral view? My c-arm doesn't produce great lateral view images, especially in thicker patient. so I'm not sure how reliable it would be to look at lateral view images for epidural space confirmation.
You should try guidewire. been using glass LOR with 14g needle since fellowship, then started using coude curve needle, much easier to thread wires in and avoid anterior placement. but coude curve tip needle didn't give reliable LOR, so tried guidewire to test for epidural space. Then I realized quite a few times when I didn't get LOR with coude needle, but when inserting the guidewire, it went right in and the needle tip was already in the epidural space (advance the guidewire/coude needle on lateral view)!Man, sometimes I feel like you are living in a different dimension than the rest of us.
I use glass and use the kits with disposable ones. Occasionally autoclave a few for backup. Couldn't tell you what settings.anyone autoclave your glass LOR syringe? what setting do you use?
can't get used to plastic LOR, so will stay with glass. don't have autoclave yet, but plan to autoclave glass LOR syringe when I get one later.
Review the mri and you will know.I'm trying to use CLO for all ILESI including lower lumbar ILESI for stenosis. I am finding though that in the 70+ central stenosis crowd entering at L4-5 using a 45 degree CLO that my LOR is frequently occurring beyond the expected VILL (SLL). Not certain if it is the lordotic curve, a really thick ligamentum flavum or if 45 degrees is not enough oblique.
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I'm surprised at how many people are still doing these seated. We learned seated position no fluoro during residency and fellowship in the stone age. Taught them in the same fashion very early in my career and stressed the crap out of me every time.I learned seated position with fluoro during fellowship. Forget this technique as you will scare all the nurses at whatever asc you do procedures. The only benefit of seated is that it keeps the shoulders out of the way so wouldn't need clo