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Reg Anesth Pain Med · Nov 2021
Dural puncture during lumbar epidural access in the setting of degenerative spondylolisthesis: case series and risk mitigation strategies.
- Vivek Sindhi, Christine G Lim, Anver Khan, Carlos Pino, and Steven P Cohen.
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA.
- Reg Anesth Pain Med. 2021 Nov 1; 46 (11): 992-996.
AbstractDegenerative spondylolisthesis is a common back pathology in the general adult population. Patients with this condition may present for epidural steroid injection, epidural blood patch, or epidural analgesia. We report five patients with degenerative spondylolisthesis who experienced inadvertent dural puncture during interlaminar epidural steroid injection attempts: four with intrathecal contrast spread or cerebrospinal backflow into the epidural needle and one with subdural contrast spread. Patients with degenerative spondylolisthesis may be at higher risk for dural puncture due to stretching of the dura and contraction of the epidural space at the translated spinal level. In the following report, we summarize the cases and suggest risk mitigation strategies for both chronic and acute pain physicians.© American Society of Regional Anesthesia & Pain Medicine 2021. No commercial re-use. See rights and permissions. Published by BMJ.
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