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Cervical Interlaminar Epidural Lysis
Dr. Racz evaluates a patient while in pre-op to identify the involved cervical nerve roots for which to treat with the lysis of adhesion procedure. He then performs a cervical lysis to treat the left C5-C6 levels by entering at the C7-T1 level.
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Dr. Racz explains why he uses a RX-@ Coude needle for both its safety and ability to accurately guide the catheter to the intended injection site. He demonstrates the proper loss of resistance technique and also details the injectates used for the cervical spine, as they differ in volumes from those used in the lumbar spine.
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Dear Alex, I am delighted to have met you and hope you remember the RX2 Coude Needle technique for cervical ventral lateral catheter placement to the precise target site. I did recommend to you during the cadaver session to review the 15 minute catheter technique on Paincast for Cervical Neuroplasty. To understand and appreciate what you can do. Your question about oblique contra-lateral needle placement, I believe to be “Fools Gold”, some even claimed with minimal experience as it to be a very good technique. It is a disaster waiting to happen for multiple reasons, if you miss the entry point towards the needle placement side when you get into the epidural place, the Touhy needle can be right in the spinal cord. If you do a single needle injection, it can loculate and cause ischemic cord injury. Not long ago, I was in a court case jury trial where the patient developed a syrinx within 3 weeks. Another case with contra-lateral needle placement had an intra-cord injection with a very large settlement, other case with a catheter threaded into the cord. Any oblique view is going to get you, but the incidence may be 1 in 10-12000 and there are no studies to contradict what I am saying. We pretty well stopped doing single shot Touhy needle ESI’s because of multiple intra-cord injections, most of these cases settle and are very difficult publish. Therefore you don’t see them. You can see the catheter in the ventral lateral epidural space, you can aspirate and inject contrast to confirm safety, the injection of contrast, hyaluronidase, hypertonic saline has been well studied and gives the longest lasting results and reduction of additional procedures and surgeries. You cannot do any of that with the same safety with the contra-lateral technique.
Best Regards,
Gabor B. Racz, M.D., ABIPP, FIPP
Grover E. Murray Professorship
Past President WIP
EXCELLENT VIDEO, CONGRATULATIONS TO THE FRIENDS OF SPAIN AND SPECIAL ONE TO THE PROFESSOR RACZ.
TO WHOM IF POSSIBLE, I WOULD LIKE TO ASK ABOUT USING THE ARC IN C IN …. OBLIQUE CONTRALATERAL POSITION, FOR THE DISPLAY OF THE NEEDLE TO TIME OF ENTRY TO THE EPIDURAL SPACE.
THANKS A LOT.
DR. ALEX LA FUENTE
LA PAZ – BOLIVIA
http://www.praxisdeldolor.com