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Cadaveric Study Of Percutaneous Cervical Epidural Catheterization Through The Sacral Hiatus 2014

Category Interventional Oganes Ashikyan, MD Roy Riascos, MD Farhood Firouzbakht, MS Lauren Layer, MD Lisa Vu, MD Purpose The purpose of this study was to evaluate feasibility of access to the epidural space of the cervical spine from the sacral hiatus approach without puncture of the thecal sac and without encountering obstruction from normal anatomical structures. Materials & Methods Epidural catheterizations were performed on two cadavers. Using fluoroscopy guidance, Terumo angled tip 0.035 glidewire and Terumo Glidecath 5 Fr angled tip catheter were advanced into the cervical epidural space. Contrast injection was performed and fluoroscopic images obtained. An autopsy was performed on the recently deceased cadaver. Results There was no CSF leak through the catheter during the entire procedure. Fluoroscopic images obtained after the injection of contrast confirmed epidural placement of the catheter tip. The ability to manipulate the position of the catheter tip within the epidural space was maintained throughout the procedure. The autopsy demonstrated intact thecal sac from the sacral hiatus to the most superior extent of the cervical recess. Conclusion Our study demonstrates that access to the cervical epidural space is possible via the sacral hiatus approach. References 1. Newell, R.L., The spinal epidural space. Clin Anat, 1999. 12(5): p. 375-9. 2. Gallart L, Blanco D, Samsó E, Vidal F. Clinical and radiologic evidence of the epidural plica mediana dorsalis. Anesth Analg. 1990 Dec;71(6):698-701. 3. Savolaine ER, Pandya JB, Greenblatt SH, Conover SR. Anatomy of the human lumbar epidural space: new insights using CT-epidurography. Anesthesiology. 1988 Feb;68(2):217-20. 4. Price, C.M., et al., Comparison of the caudal and lumbar approaches to the epidural space. Ann Rheum Dis, 2000. 59(11): p. 879-82. 5. Chen, C.P., et al., Ultrasound guidance in caudal epidural needle placement. Anesthesiology, 2004. 101(1): p. 181-4. 6. Senoglu, N., et al., Landmarks of the sacral hiatus for caudal epidural block: an anatomical study. Br J Anaesth, 2005. 95(5): p. 692-5. 7. Standring, S., Gray's Anatomy; The Anatomical Basis of Clinical Practice. 39 ed. 2004, London: Elsevier Churchill Livingstone. 749-779. 8. Hayek SM, Helm S, Benyamin RM, Singh V, Bryce DA, Smith HS. Effectiveness of spinal endoscopic adhesiolysis in post lumbar surgery syndrome: a systematic review. Pain Physician. 2009 Mar-Apr;12(2):419-35. 9. Geurts, J.W., et al., Targeted methylprednisolone acetate/hyaluronidase/clonidine injection after diagnostic epiduroscopy for chronic sciatica: a prospective, 1-year follow-up study. Reg Anesth Pain Med, 2002. 27(4): p. 343-52. 10. Shah, R.V. and J.E. Heavner, Recognition of the subarachnoid and subdural compartments during epiduroscopy: two cases. Pain Pract, 2003. 3(4): p. 321-5. 11. Ryu KS, Rathi NK, Kim G, Park CK. Iatrogenic intradural lumbosacral cyst following epiduroscopy. J Korean Neurosurg Soc. 2012 Nov;52(5):491-4.