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LETTER TO THE EDITOR

Fluoroscopy and Safety of Spinal Interventional Procedures

Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, mukesh_tripathi{at}yahoo.com

In Response:

We appreciate the comments of Drs. Munir, Rastogi, and Nede-ljkovic (1) for their comments on the case report of inadvertent intracord injection of triamcinolone (2) and without paresthesia in an awake-patient (3) presenting with complete paraplegia. It has continued the debate on the utility of epidurography to avoid the serious complication of paraplegia after central neuroaxial block.

In response to their questions, we did not notice cerebrospinal fluid leakage before the injection of the test dose. We did not notice difficulty during the injection. However, our current practice uses disposable plastic syringes. It might have been possible to detect increased resistance to injection had we used a glass syringe. Fluoroscopy was performed in the lateral position to confirm the needle position. Finally, we agree that training under the guidance of experienced pain physicians may reduce the incidence of severe complications.

References

1. Munir MA, Rastogi R, Nedeljkovic S. Fluoroscopy and safety of spinal interventional procedures. Anesth Analg 2006;102:1586.[Free Full Text]
2. Tripathi M, Nath SS, Gupta RK. Paraplegia after intracord injection during attempted epidural steroid injection in an awake patient. Anesth Analg 2005;101:1209–11.[Abstract/Free Full Text]
3. Tsui BCH, Armstrong K. Can direct spinal cord injury occur without paresthesia? A report of delayed spinal cord injury after epidural placement in an awake patient. Anesth Analg 2005;101:1212–4.[Abstract/Free Full Text]

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