Microcatheterization of the cervical epidural space via lumbar puncture: Technical note

OBJECTIVE: Deposition of opiates, corticosteroids, or local anesthetics int o the epidural space is useful for the management of painful maladies of th e cervical and thoracic spine. We describe a novel technique for epidural m edication delivery via an angiographic microcatheter inserted at or below t he conus and advanced cephalad under fluoroscopic guidance. Unlike commerci al kits used by anesthesiologists, this method uses a radiopaque catheter t hat can be precisely targeted to the levels of interest. The hazards of dir ect puncture, such as "wet tap" or injury to the cervical cord, are minimiz ed. METHODS: An 1S-gauge Tuohy needle is inserted into the lumbar epidural spac e. A 2.3-French microcatheter and a 0.018inch steerable guidewire are then introduced through the lumen of the needle. The catheter is fluoroscopicall y advanced to the cervical epidural space, where Depo-Medrol (Pharmacia & U pjohn, Kalamazoo, MI) is administered. As the catheter is withdrawn, additi onal corticosteroid can be delivered to the thoracic epidural space, togeth er with long-acting morphine compounds or local anesthetics. Regional press ures within the epidural space and other physiological parameters can be me asured, and the local microenvironment can be sampled. RESULTS: To date, we have performed 16 procedures for 13 patients. All pati ents reported improvement, of varying extent and duration. There have been no complications. CONCLUSION: Our system of accessing the epidural space has many advantages, compared with direct puncture and commercially available kits. It provides a safe means of delivering epidural medication to multiple spinal levels a nd permits measurement of physiological variables that may be useful in the diagnosis and treatment of cervical and thoracic spine disease.