Cervical Epidural

**gm542@** · 08-07-2008, 04:52 PM

I was always told in my first year of medical school that it was safe to perform a lumbar epidural because the spinal cord finishes and becomes the cauda equina, allowing nerves to "roll away" from an incoming needle. However, today I came across cervical epidural used for treatment of chronic pain due to disc abnormality etc and I was wondering if anyone knew why this is safe and the cord does not spasm? Is it because they generally carry the proceedure out under realtime x-ray? Cheers. Gareth

**gm542@** · 08-07-2008, 06:27 PM

Well that is what I thought (i am a 3rd year med student), but it is apparently not the case. Firstly I think you can sample CSF from the cisternae magna, however cervical (as in cervical level of the spine i.e. the neck region) epidural is a proceedure, see:

Principles and Practice of Pain Medicine - Google Book Search

Which takes place above the lumbar level for injection of steroid anaesthetic. The question was, why, anatomically, does this not cause paralysis?

**scohoust** · 08-07-2008, 06:42 PM

I think you're getting mixed up between an epidural (which occur in the epidural space) and a spinal anaesthetic (which occurs in the subarachnoid space where CSF flows). A lumbar puncture is also from the subarachnoid. These would obviously be below the lumbar section of the cord.

Does that help?

**gm542@** · 08-07-2008, 07:01 PM

I'm not getting confused with lumbar puncture, for spinal tap insertion, which would obviously be at the lumbar level. The proceedure is called "cervical epidural", although the name itself may be confusing. Epidural is a method of introducing anaesthetic to the spine so it is surely a type of spinal anaesthesia? Does epidural not carry with it the same risk of spasm due to needle insertion that lumbar puncture does (as i was told that as well)...! If not then why?

**gm542@** · 08-07-2008, 08:27 PM

Ok, yeah I think I get it now, cheers scohoust. Doesn't go deep enough to cause disruption although the space does reduce from lumbar level which is what confused me. Guess its just a precision thing...

**scohoust** · 08-07-2008, 08:27 PM

I was trying to point out that they go into two different sites - an epidural doesn't (or shouldn't!) pierce the dura whilst an LP goes further into the subarachnoid space. "Spinal anaesthesia" is typically used for describing anaesthetics that go into this space (such is my understanding).

There are some particular horror stories of epidurals which practically became spinals which I'm sure you'd find in journals.

This is purely my explanation for why cervical epidurals are possible, I may be totally wrong, but I think you're getting a bit muddled in the anatomy.