scholarly journals An Alternative Approach to Needle Placement in Cervicothoracic Epidural Injections

2012 ◽  
Vol 25 (3) ◽  
pp. 183 ◽  
Author(s):  
Seung Yong Park ◽  
Jung Gil Leem ◽  
Sung Hwan Jung ◽  
Young Ki Kim ◽  
Won Uk Koh
Keyword(s):  
Needle Placement ◽  
Epidural Injections ◽  
Alternative Approach

Ultrasound Guidance in Caudal Epidural Needle Placement

2004 ◽  
Vol 101 (1) ◽  
pp. 181-184 ◽  
Author(s):  
Carl P. C. Chen ◽  
Simon F. T. Tang ◽  
Tsz-Ching Hsu ◽  
Wen-Chung Tsai ◽  
Hung-Pin Liu ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Epidural Space ◽  
Ultrasound Guidance ◽  
Epidural Needle ◽  
Low Back ◽  
Needle Placement ◽  
Epidural Injections ◽  
Sacral Hiatus ◽  
Caudal Epidural

Background This study was conducted to investigate the feasibility of using ultrasound as an image tool to locate the sacral hiatus accurately for caudal epidural injections. Methods Between August 2002 and July 2003, 70 patients (39 male and 31 female patients) with low back pain and sciatica were studied. Soft tissue ultrasonography was performed to locate the sacral hiatus. A 21-gauge caudal epidural needle was inserted and guided by ultrasound to the sacral hiatus and into the caudal epidural space. Proper needle placement was confirmed by fluoroscopy. Results In all the recruited patients, the sacral hiatus was located accurately by ultrasound, and the caudal epidural needle was guided successfully to the sacral hiatus and into the caudal epidural space. There was 100% accuracy in caudal epidural needle placement into the caudal epidural space under ultrasound guidance as confirmed by contrast dye fluoroscopy. Conclusions Ultrasound is radiation free, is easy to use, and can provide real-time images in guiding the caudal epidural needle into the caudal epidural space. Ultrasound may therefore be used as an adjuvant tool in caudal needle placement.

scholarly journals Alternative Approach To Needle Placement In Spinal Cord Stimulator Trial/Implantation

2011 ◽  
Vol 1;14 (1;1) ◽  
pp. 45-53
Author(s):  
Jie Zhu
Keyword(s):  
Spinal Cord ◽  
Epidural Space ◽  
Ligamentum Flavum ◽  
Lumbar Spine Surgery ◽  
Low Back ◽  
Spinal Cord Stimulator ◽  
Needle Placement ◽  
Lead Placement ◽  
Loss Of Resistance ◽  
Alternative Approach

Neuromodulation with spinal cord stimulation is a proven, cost effective treatment for the management of chronic radicular low back pain from failed low back surgery syndrome and other neuropathic pain conditions. The traditionally instructed method for percutaneous spinal cord stimulator lead placement promotes the use of a “loss of resistance” technique under anteroposterior fluoroscopic guidance to assure midline lead placement and proper entry into the epidural space. Loss of resistance is a reliable method to locate the epidural space in most clinical situations. However, in certain circumstances such as a congenital underdeveloped ligamentum flavum or defects of the ligamentum flavum, sometimes occurring after lumbar spine surgery, it might become difficult to use a loss of resistance technique to locate the epidural space. In this case, the level of resistance might not be clear. Further, a false loss of resistance might occur between changes in fascial planes that might lead to the uncertainty of needle depth. This paper introduces an alternative method for needle placement for spinal cord stimulator (SCS) trials and implantation without using the traditional loss of resistance technique. The technique allows for precise visual monitoring of the Tuohy needle tip under fluoroscopy to gauge needle depth as it enters into the tissue and the epidural space based on anatomic structural landmarks. This method allows for multiple lead placement or single lead insertion multiple times in the same interlaminar space. This is an alternative approach to the loss of resistance technique based on the fluoroscopic landmarks. Theoretically, this should be a safer approach for accessing the epidural space; however, further studies are needed to evaluate its safety. Key words: spinal cord stimulator, loss of resistance, epidural access, lumbar radicular symptoms of lower limbs, neuromodulation, posterior column stimulator

1792: Technique and Accuracy of a Clinical System for Transrectal Intraprostatic Needle Placement in a Standard 1.5T MRI Scanner

2004 ◽  
Vol 171 (4S) ◽  
pp. 473-474
Author(s):  
Robert C. Susil ◽  
Jonathan A. Coleman ◽  
Axel Krieger ◽  
Kevin Camphausen ◽  
C. Norman Coleman ◽  
...  
Keyword(s):  
Needle Placement

V940: Pre-Pubic SPARC for Stress Urinary Incontinence: An Alternative Approach for Scarred Retzius Space

2004 ◽  
Vol 171 (4S) ◽  
pp. 249-249
Author(s):  
Paulo Palma ◽  
Cassio Riccetto ◽  
Marcelo Thiel ◽  
Miriam Dambros ◽  
Rogerio Fraga ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Alternative Approach

An alternative approach to treating delinquent youth

1986 ◽  
Vol 3 (3) ◽  
pp. 65-85
Author(s):  
Donald E. Weber ◽  
William H. Burke
Keyword(s):  
Delinquent Youth ◽  
Alternative Approach
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