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Caudal Epidural MIPSI

MIPSI or Minimally invasive pain and spine interventions is a broad term which encompasses all the Non-invasive and minimally invasive interventions done by the interventional spine and pain physicians for myriad of conditions right from Musculo-skeletal disorders like back pain, neck pain, knee pain etc.

What is Caudal Epidural MIPSI?


Epidural space is a potential space present in the Spinal canal around the spinal cord. Epidural MIPSI is a procedure in which an anti-inflammatory medication is injected in this Epidural space with the help of a needle under X ray guidance at the level where the patient has the actual problem. Caudal Epidural MIPSI is a technique wherein the Epidural space is accessed through the Sacral hiatus, which is an opening on the posterior aspect of the sacral bone.

Different procedures done through this approach


  • Caudal Epidural injection: In this needle is inserted through sacral hiatus till the S2 level and the solution is injected before confirmation of the location with a radiocontrast dye.
  • Caudal Epidural adhesiolysis: It is another technique which is done in Failed back surgery patients to release the adhesions formed post-surgery entrapping the spinal nerves. This involves use of specialized catheters which can be directed at the sites of compressions and help doing targeted adhesiolysis.
  • Epidural pump insertion: In this procedure a catheter is placed in the Epidural space which is then connected with a pump implanted below the skin. Medications are then injected into this pump system which delivers the medications in the Epidural space continuously at a controlled rate.

Indications


  • Prolapsed Intervertebral disc disease
  • Chronic back pain with multiple level disc disease
  • Spinal stenosis with radicular pain
  • Compression fracture of vertebra with radicular pain
  • Failed back surgery
  • Post-herpetic neuralgia
  • Carcinomas involving the pelvis or the lower extremities.

How Caudal Epidural MIPSI helps relief pain?


Caudal Epidural space is the location where the lower lumbar and sacral nerves traverse before emerging from the respective foramina and supplying the lower extremities. Accessing this space and then either doing a single shot injection or placing a continuous infusion pump helps deliver the drugs around these nerves. Pain relief occurs according to the type of medication injected which depends on the condition for which the procedure is done.


How many times this procedure has to be repeated?


Most patients need only one injection, however, some patients may need repetition of the procedure. Decision to repeat the procedure is taken by your doctor looking at your MRI and the relief percentage from previous procedure.

Epidural pump inserted works for a period of 3-4 months when it is generally removed to reduce the chances of infection.

Will I require hospitalization for this procedure?


No. This is a Day care procedure. Patient is advised about the Pre-procedure precautions before- hand. On the day of the procedure, patient arrives 2 hours before the procedure and is discharged same day after 2 hours of monitoring.

For Epidural pump insertion patient is hospitalized for 24 hours to monitor for any complications.

To see how this procedure is done