Spina bifida and interventional pain procedures

[GottaHaveIt]

Hey all,

I saw a patient with history of spina bifida today. He is being referred for possible a disc herniation. I am getting an MRI.

I have not had this situation before. Is it even safe for these type of patients to undergo interventional spine procedures? If they have incompletely formed posterior elements (plus a possible meningiocele) it seems risky to go poking around in there.

What do you guys do in this setting? Is it okay for say spina bifida occulta and not other forms?

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[cowboydoc]

Hey all,

I saw a patient with history of spina bifida today. He is being referred for possible a disc herniation. I am getting an MRI.

I have not had this situation before. Is it even safe for these type of patients to undergo interventional spine procedures? If they have incompletely formed posterior elements (plus a possible meningiocele) it seems risky to go poking around in there.

What do you guys do in this setting? Is it okay for say spina bifida occulta and not other forms?

Need imaging/history. Incomplete spinous arch formation is a weekly incidental finding. Actual meningomyelocele is a much more nuanced matter, associated with Chiari malformation until proven otherwise..

 

[lobelsteve]

Let the anatomy be your guide.

 

[BobBarker]

On the ambulatory, fully functional
Patients it will be just a little disconnect of the lamina near the spinous process. Just avoid an interlaminar there.

 

[Ducttape]

TF should not be an issue, but look at your MRI.

 

[BloodySurgeon]

Depends on location, type, and surgical history. I would avoid injecting at exact location and agree would either recommend TF or alternative level ILESI.