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The contralateral oblique fluoroscopic view is associated with a lower incidence of postdural puncture headache in patients undergoing percutaneous spinal cord stimulation.

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Title: The contralateral oblique fluoroscopic view is associated with a lower incidence of postdural puncture headache in patients undergoing percutaneous spinal cord stimulation.
Authors: Madan, Elena, Hussain, Nasir, Gill, Jatinder S., Simopoulos, Thomas T.
Source: Pain Practice. Nov2023, Vol. 23 Issue 8, p886-891. 6p.
Subjects: Spinal cord, Conservative treatment, Transdermal medication, Retrospective studies, Autologous blood patch, Fluoroscopy, Drug administration, Headache, Odds ratio, Wounds & injuries, Neural stimulation
Abstract: Background: Spinal cord stimulation (SCS) is a minimally invasive therapy that is increasingly used to treat refractory neuropathic pain. Although this technique has a low incidence of serious long‐term adverse sequelae, the risk of complications such as inadvertent dural puncture remains. Objectives: The goal of this article was to determine the impact of the contralateral oblique (CLO) fluoroscopic view incidence of postdural puncture headache (PDPH) during spinal cord stimulator implantation as compared to lateral fluoroscopic view. Methods: This was a single academic institution retrospective analysis of electronic medical records spanning an approximate 20‐year time period. Operative and postoperative notes were reviewed for details on dural puncture, including technique and spinal level of access, the development of a PDPH, and subsequent management. Results: Over nearly two decades, a total of 1637 leads inserted resulted in 5 PDPH that were refractory to conservative measures but responded to epidural blood patch without long‐term complications. The incidence of PDPH per lead insertion utilizing loss of resistance and lateral fluoroscopic guidance was 0.8% (4/489). However, adoption of CLO guidance was associated with a lower rate of PDPH at 0.08% (1/1148), p < 0.02. Conclusions: The incorporation of the CLO view to guide epidural needle placement can decrease the odds of a PDPH during percutaneous SCS procedures. This study further provides real‐world data supporting the potential enhanced accuracy of epidural needle placement in order to avoid unintentional puncture or trauma to deeper spinal anatomic structures. [ABSTRACT FROM AUTHOR]
Copyright of Pain Practice is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: The contralateral oblique fluoroscopic view is associated with a lower incidence of postdural puncture headache in patients undergoing percutaneous spinal cord stimulation.
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22Pain+Practice%22&quot;&gt;Pain Practice&lt;/searchLink&gt;. Nov2023, Vol. 23 Issue 8, p886-891. 6p.
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Spinal+cord%22&quot;&gt;Spinal cord&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Conservative+treatment%22&quot;&gt;Conservative treatment&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Transdermal+medication%22&quot;&gt;Transdermal medication&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Retrospective+studies%22&quot;&gt;Retrospective studies&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Autologous+blood+patch%22&quot;&gt;Autologous blood patch&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Fluoroscopy%22&quot;&gt;Fluoroscopy&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Drug+administration%22&quot;&gt;Drug administration&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Headache%22&quot;&gt;Headache&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Odds+ratio%22&quot;&gt;Odds ratio&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Wounds+%26+injuries%22&quot;&gt;Wounds &amp; injuries&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Neural+stimulation%22&quot;&gt;Neural stimulation&lt;/searchLink&gt;
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  Data: Background: Spinal cord stimulation (SCS) is a minimally invasive therapy that is increasingly used to treat refractory neuropathic pain. Although this technique has a low incidence of serious long‐term adverse sequelae, the risk of complications such as inadvertent dural puncture remains. Objectives: The goal of this article was to determine the impact of the contralateral oblique (CLO) fluoroscopic view incidence of postdural puncture headache (PDPH) during spinal cord stimulator implantation as compared to lateral fluoroscopic view. Methods: This was a single academic institution retrospective analysis of electronic medical records spanning an approximate 20‐year time period. Operative and postoperative notes were reviewed for details on dural puncture, including technique and spinal level of access, the development of a PDPH, and subsequent management. Results: Over nearly two decades, a total of 1637 leads inserted resulted in 5 PDPH that were refractory to conservative measures but responded to epidural blood patch without long‐term complications. The incidence of PDPH per lead insertion utilizing loss of resistance and lateral fluoroscopic guidance was 0.8% (4/489). However, adoption of CLO guidance was associated with a lower rate of PDPH at 0.08% (1/1148), p &lt; 0.02. Conclusions: The incorporation of the CLO view to guide epidural needle placement can decrease the odds of a PDPH during percutaneous SCS procedures. This study further provides real‐world data supporting the potential enhanced accuracy of epidural needle placement in order to avoid unintentional puncture or trauma to deeper spinal anatomic structures. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Pain Practice is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=173516776
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/papr.13265
    Languages:
      – Code: eng
        Text: English
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        PageCount: 6
        StartPage: 886
    Subjects:
      – SubjectFull: Spinal cord
        Type: general
      – SubjectFull: Conservative treatment
        Type: general
      – SubjectFull: Transdermal medication
        Type: general
      – SubjectFull: Retrospective studies
        Type: general
      – SubjectFull: Autologous blood patch
        Type: general
      – SubjectFull: Fluoroscopy
        Type: general
      – SubjectFull: Drug administration
        Type: general
      – SubjectFull: Headache
        Type: general
      – SubjectFull: Odds ratio
        Type: general
      – SubjectFull: Wounds & injuries
        Type: general
      – SubjectFull: Neural stimulation
        Type: general
    Titles:
      – TitleFull: The contralateral oblique fluoroscopic view is associated with a lower incidence of postdural puncture headache in patients undergoing percutaneous spinal cord stimulation.
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            NameFull: Madan, Elena
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            NameFull: Hussain, Nasir
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            NameFull: Gill, Jatinder S.
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              M: 11
              Text: Nov2023
              Type: published
              Y: 2023
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