frequent procedures
 

DIAGNOSTIC EPIDUROGRAPHY (EPIDUROGRAM)
Diagnostic epidurography is done in order to delineate the boundaries or borders of the epidural space at the target level of the axial spine of any one particular patient. Through the definition of the outline of the epidural space in this patient, areas of filling defects can be identified. These areas of filling defects at the likely sites or area of scar tissue formation or “foreign body” location like an extruded disk or a herniated disk that may be present and causing symptoms for the patient. Localization of such pathology can then help in the subsequent treatments that the patient may receive, such as epidural lysis of adhesions in order to achieve pain resolution or relief.

An epidurogram is done under fluoroscopic guidance at the desire level, which may be cervical, thoracic, lumbar, or sacral. During an epidurogram, careful placement of needle is usually done in a central location along the axial spine followed by dye injection into the epidural space and radiographic documentation of the spread of this dye. On completion of this process, the physician is able to make an informed analysis or diagnosis, or hypothesis, as the case may be regarding the etiology of the patient’s pain. Contrast material is injected in high volume, usually, and depending on the level that is being accessed, sometimes may vary from 5-cc of contrast material to 20-cc to 30-cc of contrast material.

INDICATIONS:
1. Post laminectomy syndrome.
2. Lumbar or cervical diskogenic pain with leak and epidural fibrosis.
3. Extrusion and migration of this material following disk herniation. There are other indications as well.

CONTRAINDICATIONS:
1. Patient’s who are pregnant or suspect that they are pregnant should not undergo this procedure, and should notify the physician immediately.
2. Patient’s who are on Coumadin or other blood thinners, or Heparin should not undergo this procedure. However, Coumadin can be stopped for about three days with the knowledge and consent of the prescribing physician before this procedure can be done.

COMPLICATIONS: Complications in epidurogram are rare, and may include allergy to contrast dye, spinal headaches, among others.

SEDATIVES: The procedure is usually quick and benign, and does not require sedation. However, patients who are anxious or request medication will have that medication available to them prior to the procedure.

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