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Spinal anaesthesia (or spinal anesthesia), also called spinal block, subarachnoid block, intradural block and intrathecal block, [1] is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subarachnoid space, generally through a fine needle, usually 9 cm (3.5 in) long.
Mayo Clinic Hospital is one of three teaching hospitals in Jacksonville, along with UF Health Jacksonville, located in North Jacksonville, and Wolfson Children's Hospital in downtown Jacksonville. An expansion announced in 2022 will increase the total number of beds from 304 to 428 in 2026.
Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. [6] Symptoms may include pain, numbness , or weakness in the arms or legs. [ 1 ]
Cordotomy can be highly effective in relieving pain, but there are significant side effects. These include dysesthesia (abnormal sensation), [1] urinary retention and (for bilateral cervical cordotomy) apnea during sleep (acquired central hypoventilation syndrome) caused by inadvertent division of the reticulospinal tracts. [2]
A large study of spinal stenosis from Finland found the prognostic factors for ability to work after surgery were ability to work before surgery, age under 50 years, and no prior back surgery. The very long-term outcome (mean follow-up time of 12.4 years) was excellent-to-good in 68% of patients (59% women and 73% men).
A spinal CSF leak can be caused by one or more meningeal diverticula or CSF-venous fistulas not associated with an epidural leak. [6] [7] [8] A spontaneous spinal cerebrospinal fluid leak may occur sometimes in those with predisposing heritable connective tissue disorders including Marfan syndrome and Ehlers–Danlos syndromes.
In adults, the spinal cord terminates around the level of the disc between L1 and L2, while in neonates it extends to L3 but can reach as low as L4. [16] Below the spinal cord there is a bundle of nerves known as the cauda equina or "horse's tail". Hence, lumbar epidural injections carry a low risk of injuring the spinal cord.
[20] [21] [23] A double-blind, randomized, controlled surgery trial found a 22% cure rate for the surgery group and a 4% cure rate for the sham surgery group, suggesting that these cure rates cannot be purely attributable to the natural history of the disease or a placebo effect.