Lumbar Discogram - transthecal approach

[ampaphb]

Colleague did a, L2/3 - L5/S1 discogram using a transthecal approach. I thought this was unusual (no contraindications to going extrapedicular). Thoughts?

---

Members don't see this ad.

 

[Tenesma]

sounds foolish to me...

 

[SSdoc33]

patient get a headache?

certainly unusual.

 

[emd123]

What's the advantage of going transthecal? I don't get it.

 

[Aether2000]

I have done this numerous times but it should not be used as the initial approach. Spinal headache 10-15%.

 

[myrandom2003]

Repeat procedure for blood patch
Dolla dolla bills y'all

 

[Pacman27]

What's your approach for doing the transthecal?
What Gauge needle and do you use an introducer
I would think with a 25 G needle the risk should of PDPH should be low and for some of the difficult
L5/S1 might be a reasonable thought to get to the center of the disc and save time
Also, other then the PDPH any other major risk to doing this approach

 

[ampaphb]

What I found unusual was that he did a 4 level disco, using this approach at all levels

 

[Tenesma]

again... very foolish...

 

[DOctorJay]

repeat procedure for blood patch
dolla dolla bills y'all

cream

 

[Aether2000]

Wowza....4 level, transthecal! Sure this wasn't a CRNA?

 

[NOSfan]

Yes, extrapedicular should be the preferred approach unless otherwise contraindicated (hardware, excessive os formation, osteophyte or other anatomical variation that may prevent access such as that occasionally seen at L5-S1).

 

[lobelsteve]

Sounds like someone didn't do a fellowship and just picked up a spine model and said I can do a disco.

Pressure manometry?
Results match imaging?
Needs fusion real bad?
Love you long tim.

 

[Ligament]

Why? If there is a valid reason id love to hear it. Insuppose there might be a reason to do this, though i cannot think of one

 

[Aether2000]

There may be a reason for a one level, esp L5S1 on rare occasions, but 4 levels? puhleeze!!!

 

[geauxg8rs]

only advantage I can see is that their rip roaring spinal headache will take supercede their increased back pain from the disco.

Or maybe the patient needs therapeutic wet taps for high CSF state? kind of a two for one?

 

[knoxdoc]

He hates that dura!!! (Yell it like Steve Martin in The Jerk)