FL and imaging of the spine Flashcards
What is a Epidural Steroid Injection (ESI)?
An epidural steroid injection which places the medication (Steroid) into the epidural space surrounding the sac containing the spinal fluid and nerve roots.
ESI – the idea and goal is to spread the medication over a wide area in the spine and hopefully decrease inflammation.
How is ESI given?
The needle goes through the ligamentum flavum into the epidural space
We’re going to inject a concoction of local anaesthetic and steroids to enable some long term symptom relief
Rare Possible complications with ESI?
Facial Flushing
Elevated blood sugars in diabetic patients
Infection (e.g Meningitis)
Bleeding
Headache
Temporary numbness of the legs.
There are others so always expect the unexpected
What is Nerve Root Block (NRB)?
A nerve root block places medication directly adjacent to the nerve root causing the pain.
This results in a much more targeted area.
Often used in the treatment of “trapped neve” possibly caused by either foraminal stenosis (narrowed exit hole), slipped disc or by a slipped back bone (spondylolisthesis).
Treatment may help with the pain but is not a cure.
NRB – this may not be suitable for all patients who may have multiply targeted areas of pain.
By reducing the pain and nerve swelling caused by a disc prolapse, many can then heal and possible shrink which could potentially avoid the need for surgery.
What is Facet Joint Injection?
Injection placing medication directly into the targeted facet joints of the spine.
Pain often caused by degenerative changes or injury
Lower back can be felt in the buttocks and upper legs
Neck can be felt in the upper back and shoulder and sometimes spread to the back of the head
Adjacent muscles can also become tight and painful
FI – degenerative changes in these joints can cause distinct pain symptoms, which are not well treated by injection into the epidural space or along nerve roots.
facet joint are the joints that allow us to move
Diagnostic vs Therapeutic Injection what is each?
Diagnostic injection refers to injection that is used to figure out which facet joint is causing pain. For example, someone may say they are very problems with an area of their back but not sure which vertebral level it is. Or which side.
In this case an short acting LA is given to one joint, and the patient will use a pain diary to track symptoms.
If it helped then a therapeutic injection is given which is long lasting steroid to help with the pain.
What is Lumbar Puncture?
A procedure that allows a hollow needle to be inserted into the area containing spinal fluid that surrounds the spinal cord and brain.
A sample of the cerebrospinal fluid (CSF) to be examined in the laboratory.
The needle is inserted between two lumbar vertebrae and can be performed under fluoroscopic guidance.
What is CSF?
Fluid contained in the central canal of spinal cord, subarachnoid space and cerebral ventricles
Clear, colourless, transparent fluid
Water (99%)
Mineral Salts (sodium, calcium, potassium, amongst others)
Glucose
Amino Acids
Creatinine/Urea (trace amounts)
Lymphocytes
Alkaline
Absorption of CSF
Mostly absorbed by Arachnoid Villi on the Arachnoid Mater into the Dural (Venous) Sinuses
The absorption is determined by the pressure differences on each side of the villi walls.
🡹 CSF pressure, 🡻venous pressure, CSF passes into blood
🡹 venous pressure, 🡻 CSF pressure, arachnoid villi collapse preventing passage of Blood constituents into CSF
CSF can help diagnose what?
Bacterial, fungal and viral infections
Including meningitis, encephalitis and syphilis
Bleeding around the brain
Subarachnoid haemorrhage
Certain cancers involving the brain or spinal cord
Certain inflammatory conditions of the nervous system such as
Multiple sclerosis
Guillain-Barre syndrome
LP possible complications
Post-lumbar puncture headache
Back discomfort or pain
Bleeding
Brainstem herniation
There are others so always expect the unexpected
Headache - Up to 25 percent of people who have undergone a lumbar puncture develop a headache afterward due to a leak of fluid into nearby tissues.
The headache typically starts several hours up to two days after the procedure and may be accompanied by nausea, vomiting and dizziness. The headaches are usually present when sitting or standing and resolve after lying down. Post-lumbar puncture headaches can last from a few hours to a week or more.
Back discomfort or pain. You may feel pain or tenderness in your lower back after the procedure. The pain might radiate down the back of your legs.
Bleeding. Bleeding may occur near the puncture site or, rarely, into the epidural space.
Brainstem herniation. Increased pressure within the skull (intracranial), due to a brain tumor or other space-occupying lesion, can lead to compression of the brainstem after a sample of cerebrospinal fluid is removed.
A computerized tomography (CT) scan or MRI prior to a lumbar puncture can be obtained to determine if there is evidence of a space-occupying lesion that results in increased intracranial pressure. This complication is very rare.
What is Sacroiliac joint injection?
The procedure aim is to confirm that irritation or damage to the SI joint is the source of the symptoms.
It is also a therapeutic procedure which can offer significant pain relief.
Pain relief is usually short lived and is not cure.
Up to three injections may be given within a six-monthly time frame, depending on individual circumstances.
Sacroiliac joint injection possible complications
Back discomfort or pain
Bleeding
Bruising and/or soreness at the injection site
Infection at the injection site, deeper tissues, or in the joint itself
Allergic reaction to the medication
There are others so always expect the unexpected
Back discomfort or pain. You may feel pain or tenderness in your lower back after the procedure. The pain might radiate down the back of your legs.
Bleeding. Bleeding may occur near the puncture site or, rarely, into the epidural space.
What are dematomes?
An area of skin supplied by a single nerve.
Used to determine which spinal nerve may have pathology
Used a lot by radiologists/surgeons to isolate correct nerve for blocking
What is Myelography?
MRI is now considered the gold standard.
Fluoroscopy is used when patients have contraindications for MRI.
Contrast is administered into the space around the spinal cord (subarachnoid space) to evaluate the spinal cord, nerve roots and meninges.
In many cases following Myelography, CT is used to better define any abnormalities.
Tumours involving bony spine, meninges, nerve roots or the spinal cord.
Infection involving the bony spine, intervertebral discs, meninges and surrounding soft tissues.
Inflammation of the arachnoid membrane that cover the spinal cord.
Spinal lesions caused by disease or trauma.
Can also help with surgical planning decisions.
