BACKGROUND AND PURPOSE Even in experienced hands, blind epidural steroid injections result in inaccurate needle placement in up to 30% of cases. The use of fluoroscopy and radiologic contrast material provides confirmation of accurate needle placement within the epidural space. We describe our technique and experience with contrast epidurography and therapeutic epidural steroid injections, and ...

Spontaneous intracranial hypotension presents with many symptoms including orthostatic headache, dizziness, and nausea due to cerebrospinal-fluid (CSF) leakage from the spinal dural sac. Although CSF leakage can be estimated by radioisotope (RI) cisternography or computed tomography/magnetic resonance imaging myelography, it is not easy to detect the leakage point using these modalities. Here, ...

results first needle placement without imaging resulted in blood return in 1/199 participants and positive epidurography in 179/199 (90%). minimal needle repositioning resulted in a positive epidurogram in the remaining 19 attempts. no intravascular injection patterns were observed. conclusions this compares favorably to published success rates of fluoroscopically-guided technique and was well ...

BACKGROUND If the epidural spread of contrast medium can be well correlated with the spread of local anesthetics, epidurography can predict the dermatomal distribution of the anesthetic block. The authors evaluated the relation between radiographic and analgesic spread. METHODS An epidural catheter was inserted in 90 patients, and predicted catheter tip position was recorded. The analgesic ar...

A 23-year-old primigravid patient who received epidural analgesia for pain of labour presented with persistent, apparently irremediable, unilateral analgesia. Computerized axial tomo-epidurography demonstrated absence of circumferential spread due to lateral placement of the catheter. Transforaminal escape of contrast medium into the paravertebral area had occurred and anterior and posterior mi...

BACKGROUND Thoracic epidural anesthesia (TEA) is frequently used to maintain intraoperative analgesia. After injecting the initial bolus dose of epidural local anesthetics (LA), intermittent injection of LA through an epidural catheter is required to maintain the intraoperative analgesia. For intermittent epidural administration, usually 2 - 5 mL of LA has been used. However, no studies have su...

To the Editor: The plica mediana dorsalis (PMD) is thought to be a band of connective tissue, which divides the epidural space at the dorsal midline. Existence of the PMD has been controversial since its first description in 1963 (1). The PMD has been regarded as a potential cause for unilateral epidural blockade (2, 3). For purpose of discussion, we present a case of a patient who presented fo...

고식적인 경막외 차단술의 방법은 영상증강장치의 도움 없이 맹검법에 의한 추궁간(interlaminar) 혹은 미추 접근법으 로 행해져 왔으나 시술의 정확성과 특정 병변 부위를 목표 로 할 수 없는 한계가 있다. 연구에 의하면 매우 숙련된 의 사가 시행할지라도 맹검법에 의한 경막 외 주입은 25% 이 상에서 부적절한 곳에 바늘이 위치한다고 했다. 또한 경 막외 스테로이드 주입의 유용성에 관한 과거 연구들의 주 된 문제점들은 주로 맹검법을 사용하였다는 것이다. 따라 서 경막외강 내 바늘이 정확하게 있는지 혹은 혈관 내나 척수강 내 주입을 확인하기 위해서 조영제를 사용하여 영 상증강장치로 확인하는 것은 매우 중요하다. 기술적으로 경막외강에 접근할 수 있는 방법은 추궁간, 미추 접근법과 경추간공 경막외 스테로...