Oblique Intrathecal Injection in Lumbar Spine Surgery: A Technical Note

Jewett, Gordon; Yavin, Daniel; Dhaliwal, Perry; Whittaker, Tara; Krupa, JoyAnne; Plessis, Stephan du

doi:10.1017/cjn.2017.45

Cited by 3 publications

(3 citation statements)

References 20 publications

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“…Care will be taken to tilt the needle upward to avoid cutting the ligaments and dural fibres. The approximate distance between the epidural space and the skin is typically 45–60 mm, but it may be longer in obese patients 40. The needle will be advanced step by step, and after an obvious breakthrough, the core needle will be removed to check for CSF outflow.…”

Section: Methods and Analysismentioning

confidence: 99%

“…The approximate distance between the epidural space and the skin is typically 45–60 mm, but it may be longer in obese patients. 40 The needle will be advanced step by step, and after an obvious breakthrough, the core needle will be removed to check for CSF outflow. If CSF does not flow out, the core needle will be reinserted, and its orientation will be carefully adjusted (each adjustment will be recorded as an additional attempt).…”

Section: Methods and Analysismentioning

confidence: 99%

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Computerised modified paramedian approach technique versus conventional midline approach technique of lumbar puncture: a randomised control trial protocol

Zhuang,

Chen,

Lin

et al. 2024

BMJ Open

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IntroductionThe lumbar puncture (LP) technique is widely used for diagnostic and therapeutic purposes. In recent years, the paramedian approach technique (PAT) has gained increasing interest due to its advantages over the conventional midline approach technique (MAT) that has been traditionally employed in clinical practice for LP. However, there have been inconsistent discussions regarding the efficacy of different LP techniques. Based on digital virtual human and computer simulation techniques, a new approach called computerised modified PAT (CMPAT) was proposed. Therefore, the aim of this study is to discuss a randomised controlled trial (RCT) protocol to investigate and compare the effects of CMPAT and MAT in patients undergoing LP.Methods and analysisWe will conduct a prospective, multicentre RCT. The study will recruit 84 patients aged 18–99 years who require LP. Participants will be randomly assigned to either the CMPAT treatment group (group A) or the MAT treatment group (group B). The primary outcome measure will be the number of needle insertion attempts required for a successful LP. Secondary outcomes will include the puncture success rate, pain assessment in the back, head, and legs, and the occurrence of complications. The measurement of these secondary outcomes will be taken during the procedure, as well as at specific time points: 30 min, 6 hours, 1 day, 3 days, 7 days, 2 weeks and 4 weeks after the procedure. Pain levels will be assessed using a Numerical Rating Scale.Ethics and disseminationEthical approval (2022YF052-01) has been obtained from the Ethics Committee of Fujian Medical University Union Hospital, Fuzhou, China. The research findings will be published in an international peer-reviewed scientific journal and presented at scientific conferences.Trial registration numberChiCTR2300067937.

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Section: Methods and Analysismentioning

confidence: 99%

Section: Methods and Analysismentioning

confidence: 99%

Computerised modified paramedian approach technique versus conventional midline approach technique of lumbar puncture: a randomised control trial protocol

Zhuang,

Chen,

Lin

et al. 2024

BMJ Open

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“…The mitogen-activated protein kinase (MEK1) inhibitor PD98059 (Cell Signaling Technology, EMD Millipore, Billerica, MA, USA), the CCR2 antagonist, RS504393 (Tocris Bioscience, Bristol, UK), CCL2 (R & D Systems, Minneapolis, MN, USA), and the selective blocker of the NMDAR GluN2B subunit, Ifenprodil, (Sigma, New York, NY) were used in this study. For intrathecal injection, under brief anesthesia with isoflurane a lumbar puncture was made at L5–L6 with a 30-gauge needle as previously described [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

Spinal CCL2 Promotes Pain Sensitization by Rapid Enhancement of NMDA-Induced Currents Through the ERK-GluN2B Pathway in Mouse Lamina II Neurons

Zhang

Gao

et al. 2020

Neurosci. Bull.

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Previous studies have shown that CCL2 (C–C motif chemokine ligand 2) induces chronic pain, but the exact mechanisms are still unknown. Here, we established models to explore the potential mechanisms. Behavioral experiments revealed that an antagonist of extracellular signal-regulated kinase (ERK) inhibited not only CCL2-induced inflammatory pain, but also pain responses induced by complete Freund’s adjuvant. We posed the question of the intracellular signaling cascade involved. Subsequent experiments showed that CCL2 up-regulated the expression of phosphorylated ERK (pERK) and N-methyl D-aspartate receptor [NMDAR] subtype 2B (GluN2B); meanwhile, antagonists of CCR2 and ERK effectively reversed these phenomena. Whole-cell patch-clamp recordings revealed that CCL2 enhanced the NMDAR-induced currents via activating the pERK pathway, which was blocked by antagonists of GluN2B and ERK. In summary, we demonstrate that CCL2 directly interacts with CCR2 to enhance NMDAR-induced currents, eventually leading to inflammatory pain mainly through the CCL2–CCR2–pERK–GluN2B pathway.

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Intrathecal morphine injection in anterior lumbar and lateral lumbar spine surgery: technical note

Khawaja

2021

J Spine Surg

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Oblique Intrathecal Injection in Lumbar Spine Surgery: A Technical Note

Abstract: Oblique dural puncture was not associated with increased incidence of postoperative CSF leakage. This safe and reliable method of delivery of ITM should therefore be routinely considered in lumbar spine surgery.

Cited by 3 publications

References 20 publications

Computerised modified paramedian approach technique versus conventional midline approach technique of lumbar puncture: a randomised control trial protocol

Computerised modified paramedian approach technique versus conventional midline approach technique of lumbar puncture: a randomised control trial protocol

Spinal CCL2 Promotes Pain Sensitization by Rapid Enhancement of NMDA-Induced Currents Through the ERK-GluN2B Pathway in Mouse Lamina II Neurons

Intrathecal morphine injection in anterior lumbar and lateral lumbar spine surgery: technical note

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