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Single Stick, Microcatheter Directed Epidural Injections in the Cervical, Thoracic and Lumbar Spine 2014

Category Interventional James N. Jones, M.D., Sr. member, ASNR, Member, ASSR
Victor S. Clampitt, MSRT (R)(MR)
Purpose To describe single stick, multilevel microcatheter directed epidural steroid injections in the cervical, thoracic, and lumbar spine. Materials & Methods In the cervical spine, we have performed over 300 procedures, and injected an average of 2.5 levels per procedure, utilizing a single translaminar approach at T1-2. We advance a 3 fr. microcatheter under flouroscopic guidance, and attempt to steer the catheter as close as possible to the affected nerve root(s), right and left, before injecting steroid. We believe the technique is a reasonable alternative to standard translaminar techniques as well as transforaminal techniques. We have recently expanded the technique to include thoracic and lumbar epidural injections. Results At 10 days post procedural follow-up 79 % of patients describe "significant" pain relief, 13% describe "moderate" relief, and 5.5% described no discernable relief. With increased experience in catheter manipulation in the epidural space, we believe our outcomes have improved over time. We have recently gone to a "percent relief" and a "VAS" scale at the suggestion of our neurosurgical collegues. In the cervical spine, at 10 days post procedural followup, 79 In the cervical spine, at ten days post procedural followup, seventy nine percent of patients described "significant" pain relief, 13 percent described "moderate" relief, and 5.5 percent described no discernable relief. With increased experience in catheter manipulation in the epidural space, we believe are outcomes have improved over time. We have recently gone to a "percent relief" and "VAS" scale at the suggestion of our neurosurgical collegues. Conclusion Single stick, microcatheter directed multilevel epidural injections, particularly in the cervical spine appear to be a reasonable alternative to more classic techniques, particularly transforaminal injections. References 1. Cohen, S.P., et al. "Epidural Steroids; A Comprehensive Evidence-Based Review" Anesthesia and Pain Medicine, 2013, 175-200. 2. Kloth, D., et al. "Improving the Safety of Transforaminal Epidural Steroid Injections in the Treatment of Cervical Radiculopathy" Pain Physician, 2011, 3:15, pp. 285-293. 3. Kahn, et.al. "Targeted Cervical Epidural Injection Using a Radiopaque Catheter-A Technical Report" American Academy of Pain Medicine - 24th Annual Meeting (p. 201), 2008 4. Mathis, J.M. & Golovac, S. "Image Guided Spine Interventions" (2nd Edition), 2010. New York: Springer Science + Business Media Pain Physician, 2011, 315