Cervical epidural depth: correlation between needle angle, cervical anatomy, and body surface area.

OBJECTIVES: Prior to performing a cervical interlaminar epidural steroid injection (CIESI), knowledge of the depth from lamina to epidural space may assist in preventing cord injury. METHODS: This is a prospective analysis of data including gender, age, weight, height, previous surgery, neck circumference, distances from tip of chin to sternal notch, occiput to C7 vertebral prominence, and ear lobe to tip of shoulder, pain score, angle from C7 vertebral prominence to the back, depth at which the Tuohy needle contacted T1 vertebral lamina and depth at which the epidural space was entered was conducted with 92 subjects, average age (± standard deviation [SD]) 41.3 ± 13.2 years underwent fluoroscopically guided C7-T1 intralaminar epidural steroid injections. RESULTS: Depth to lamina was the best individual predictor with an r value of 0.86. Weight, neck circumference, and body mass index (BMI) positively correlated with depth to epidural space with r values of 0.66, 0.62, and 0.61, respectively. A linear regression model of depth to lamina for predicting depth to epidural space was accurate to within ± 0.5 cm of the actual depth in 69% of subjects. However, when comparing predicted with actual depth to epidural space for individual subjects, the prediction was inaccurate by as much as 1.6 cm deep or 1.7 cm shallow. CONCLUSIONS: While statistically significant correlations do exist between both quantitative external body characteristics and depth to cervical epidural space and T1vertebral lamina to depth of cervical epidural space for fluoroscopically guided interlaminar epidural steroid injections at C7-T1, even the most optimal regression models do not permit clinical confidence in predicted depth to epidural space.

Prolonged coma in a child due to hashish ingestion with quantitation of THC metabolites in urine.

BACKGROUND: Cannabinoid-containing substances are commonly abused worldwide. Significant toxicity from these substances is uncommon in adults but can result in significant symptoms in children; these symptoms are usually short-lived. OBJECTIVES: To report a case of prolonged mental status alteration of more than 2 days in a child who ingested hashish. CASE REPORT: A 14-month-old child presented comatose to a pediatric emergency department after ingestion of hashish; she did not regain consciousness for more than 48 h. Quantitative testing of the child's urine for a tetrahydrocannabinol metabolite revealed a markedly elevated level, the decline of which coincided with the child's clinical improvement. CONCLUSIONS: Significant ingestion of cannabinoid-containing substances is capable of causing prolonged symptoms (including coma) in children.