Microcatheterization of the cervical epidural space via lumbar puncture: Technical note

Arun Paul Amar, Michael Y. Wang, Donald W. Larsen, George P. Teitelbaum

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

OBJECTIVE: Deposition of opiates, corticosteroids, or local anesthetics into the epidural space is useful for the management of painful maladies of the cervical thoracic spine. We describe a novel technique for epidural medication delivery via an angiographic microcatheter inserted at or below the conus advanced cephalad under fluoroscopic guidance. Unlike commercial kits used by anesthesiologists, this method uses a radiopaque catheter that can be precisely targeted to the levels of interest. The hazards of direct puncture, such as "wet tap" or injury to the cervical cord, are minimized. METHODS: An 18-gauge Tuohy needle is inserted into the lumbar epidural space. A 2.3-French microcatheter a 0.018-inch steerable guidewire are then introduced through the lumen of the needle. The catheter is fluoroscopically advanced to the cervical epidural space, where Depo-Medrol (Pharmacia & Upjohn, Kalamazoo, MI) is administered. As the catheter is withdrawn, additional corticosteroid can be delivered to the thoracic epidural space together with long-acting morphine compounds or local anesthetics. Regional pressures within the epidural space other physiological parameters can be measured, the local microenvironment can be sampled. RESULTS: To date we have performed 16 procedures for 13 patients. All patients reported improvement, of varying extent duration. There have been no complications. CONCLUSION: Our system of accessing the epidural space has many advantages, compared with direct puncture commercially available kits. It provides a safe means of delivering epidural medication to multiple spinal levels permits measurement of physiological variables that may be useful in the diagnosis treatment of cervical thoracic spine disease.

Original languageEnglish (US)
Pages (from-to)1183-1187
Number of pages5
JournalNeurosurgery
Volume48
Issue number5
DOIs
StatePublished - 2001
Externally publishedYes

Keywords

  • Cervical pain
  • Depo-Medrol
  • Epidural analgesia
  • Microcatheter
  • Minimally invasive

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Fingerprint Dive into the research topics of 'Microcatheterization of the cervical epidural space via lumbar puncture: Technical note'. Together they form a unique fingerprint.

  • Cite this