MRI MEASURE OF THE SACRAL HIATUS TO PREDICT

MRI MEASURE OF THE SACRAL HIATUS TO PREDICT THE DIFFICULTY IN THE CAUDAL ACCESS IN EPIDUROSCOPY. Eva M 1 Monzón , David 1 Abejón , 1 Abad , Cristina Alberto 2 Carrascoso 1 Rios , Alejandro Zamora 1, Javier 1. Pain Unit. Hospital Universitario Quironsalud Madrid. 2. Radiodiagnostic Service. Hospital Universitario Quironsalud Madrid Objectives To determine the use of MRI measurement of the antero-posterior distance of the sacral canal to assess the difficulty of the caudal access to perform an epiduroscopy Methods An MRI is performed previous to the epiduroscopy with axial cuts where the antero-posterior distance at the S 4 level is measured in mm (MAPS 4). (Figure 1 a, 1 b, 2 a, 2 b) Data from 35 patients is recorded and the patients are distributed in 3 groups. Taking into account that the epiduroscope (resascope) used is 3, 3 mm in diameter and we have two types of introductors to achieve the access (the 10 F introductor measure is 3, 48 mm and the 11 F introductor measure is 4, 13 mm), the patients are distributed in group 1: sacral hiatus measure > 4, 13 mm, Group 2: measure 3, 3 -4, 13 mm, and Group 3 measure <3, 5 mm. A protocol is established in which the 11 F introductory is used in patients from group 1, in patients from group 2 the 11 F introductory is used and patients from group 3 are excluded for narrow sacral hiatus. The difficulty in the access is recorded following this protocol. Image 1 A. RM Axial. Normal sacral canal at S 4 Image 1 B. Lumbosacral RM Sagittal image. Normal Fig 2 A. RM axial. Stenotic sacral canal at S 4 1 Figure 2 B. Lumbosacral RM image. Stenotic sacral canal

MRI MEASURE OF THE SACRAL HIATUS TO PREDICT THE DIFFICULTY IN THE CAUDAL ACCESS IN EPIDUROSCOPY. Eva M 1 Monzón , David 1 Abejón , 1 Abad , Cristina Alberto 2 Carrascoso 1 Rios , Alejandro Zamora 1, Javier 1. Pain Unit. Hospital Universitario Quironsalud Madrid. 2. Radiodiagnostic Service. Hospital Universitario Quironsalud Madrid Results The measurement of the sacral hiatus is recorded in 35 patients, with a range that varies from 3, 2 mm to 9, 01 mm with a mean value of 5, 172857 mm. In group 1 there are 26 patients, no difficulty was found in the access. In group 2 there are 8 patients, no difficulty was found in the access. In group 3 there is 1 patient, the intervention is not performed. Conclusions The caudal access used in epiduroscopy occasionally offers technical difficulty. The measure of the sacral canal and the use of this protocol helps us to predict the difficulty of the access and avoid this complication in the epiduroscopy. References 1. Igarashi T, Hirabayashi Y, Seo N, Saitoh K, Fukuda H, Suzuki H. Lysis of adhesions and epidural injection of steroid/local anaesthetic during epiduroscopy potentially alleviate low back and leg pain in elderly patients with lumbar spinal stenosis. Br J Anaesth [Internet]. 2004; 93(2): 181– 7. Available from: http: //dx. doi. org/10. 1093/bja/aeh 201 2. Rajani S. Anatomical variations of sacral hiatus and associated clinical relevance - A review. Int J Anat Var. 2017; 10(4): 96 -98. 2