title: Catheter-Based Trans-Epidural Approach to Aspirate Cervical and Thoracic Epidural Abscesses: A Cadaveric Feasibility Study.
abstract: BACKGROUND
  Approaching and aspirating cervical and high thoracic epidural abscesses through a trans-epidural route from the lumbar region access represents an alternative method for selected patients.
  
  
  OBJECTIVE
  We determined the feasibility of catheter-based manipulation and aspiration using the trans-epidural route.
  
  
  METHODS
  A custom designed infusion-suction catheter system that includes an outer suction catheter and inner infusion catheter in concentric relation with radio-opaque marker bands was tested in a cadaveric preparation to determine (1) the ability to place an aspiration catheter over a guidewire using a percutaneous approach within the posterior lumbar epidural space; (2) the highest vertebral level a catheter can be advanced within the epidural space; and (3) the ability to aspirate artificial purulent-like material placed in the cervical and thoracic level epidural space.
  
  
  RESULTS
  We were able to advance two infusion-suction catheter systems from a 14G Touhy spinal needle inserted via an oblique parasagittal approach at the L2-L3 intervertebral space. The infusion-suction catheter was advanced up to the level of the cervical vertebral level of C2 within the epidural space under fluoroscopic guidance. We were able to aspirate artificial purulent-like material directly injected with a 22G Quincke spinal needle at vertebral levels C4-C5 and at vertebral levels T10-T11 by aspiration and manipulation of the outer catheter within the epidural space at levels C3-C7 and T9-L1, respectively.
  
  
  CONCLUSIONS
  Our observations support the further exploration of a percutaneous catheter-based trans-epidural approach to treat epidural abscesses. The trans-epidural approach may be used alone or as a staged or concurrent approach with open surgical treatment.
authors.affiliation: Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, United States.
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
authors.affiliation: Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, United States.
authors.forename: Mushtaq H
authors.initials: MH
authors.lastname: Qureshi
authors.affiliation: Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, United States.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Malik
authors.affiliation: Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, United States.
authors.forename: Vikram
authors.initials: V
authors.lastname: Jadhav
authors.affiliation: Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, United States.
authors.forename: Stanley H
authors.initials: SH
authors.lastname: Kim
mesh_terms: D002102:Cadaver; D057785:Catheters; D002574:Cervical Vertebrae; D020802:Epidural Abscess / Q000601:surgery*; D005240:Feasibility Studies; D005471:Fluoroscopy; D006801:Humans; D019152:Paracentesis / Q000379:methods*; D013904:Thoracic Vertebrae