{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T11:54:20Z","timestamp":1765886060055},"reference-count":19,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2017,5,8]],"date-time":"2017-05-08T00:00:00Z","timestamp":1494201600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can. J. Neurol. Sci."],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold><jats:italic>Objectives:<\/jats:italic><\/jats:bold>Intrathecal morphine (ITM) is an efficacious method of providing postoperative analgesia and reducing pain associated complications. Despite adoption in many surgical fields, ITM has yet to become a standard of care in lumbar spine surgery. Spine surgeons\u2019 reticence to make use of the technique may in part be attributed to concerns of precipitating a cerebrospinal fluid (CSF) leak.<jats:bold><jats:italic>Methods:<\/jats:italic><\/jats:bold>Herein we describe a method for oblique intrathecal injection during lumbar spine surgery to minimize risk of CSF leak. The dural sac is penetrated obliquely at a 30\u00b0 angle to offset dural and arachnoid puncture sites. Oblique injection in instances of limited dural exposure is made possible by introducing a 60\u00b0 bend to a standard 30-gauge needle.<jats:bold><jats:italic>Results:<\/jats:italic><\/jats:bold>The technique was applied for injection of ITM or placebo in 104 cases of lumbar surgery in the setting of a randomized controlled trial. Injection was not performed in two cases (2\/104, 1.9%) following preinjection dural tear. In the remaining 102 cases no instances of postoperative CSF leakage attributable to oblique intrathecal injection occurred. Three cases (3\/102, 2.9%) of transient CSF leakage were observed immediately following intrathecal injection with no associated sequelae or requirement for postsurgical intervention. In two cases, the observed leak was repaired by sealing with fibrin glue, whereas in a single case the leak was self-limited requiring no intervention.<jats:bold><jats:italic>Conclusions:<\/jats:italic><\/jats:bold>Oblique dural puncture was not associated with increased incidence of postoperative CSF leakage. This safe and reliable method of delivery of ITM should therefore be routinely considered in lumbar spine surgery.<\/jats:p>","DOI":"10.1017\/cjn.2017.45","type":"journal-article","created":{"date-parts":[[2017,5,8]],"date-time":"2017-05-08T01:22:45Z","timestamp":1494206565000},"page":"514-517","source":"Crossref","is-referenced-by-count":3,"title":["Oblique Intrathecal Injection in Lumbar Spine Surgery: A Technical Note"],"prefix":"10.1017","volume":"44","author":[{"given":"Gordon A.E.","family":"Jewett","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Yavin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Perry","family":"Dhaliwal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tara","family":"Whittaker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JoyAnne","family":"Krupa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"Du Plessis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2017,5,8]]},"reference":[{"key":"S0317167117000452_ref2","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/60.6.639"},{"key":"S0317167117000452_ref19","doi-asserted-by":"crossref","first-page":"E831","DOI":"10.36076\/ppj.2015\/18\/E831","article-title":"Catheter-tip granulomas associated with intrathecal drug delivery\u2014a two-center experience identifying 13 cases","volume":"18","author":"Kratzsch","year":"2015","journal-title":"Pain Physician"},{"key":"S0317167117000452_ref12","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/01.ana.0000167146.13415.7c","article-title":"Comparison of low-dose intrathecal and epidural morphine and bupivacaine infiltration for postoperative pain control after surgery for lumbar disc disease","volume":"17","author":"Yorukoglu","year":"2005","journal-title":"J Neurosurg Anesthesiol"},{"key":"S0317167117000452_ref1","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-198802000-00006"},{"key":"S0317167117000452_ref7","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181844ef2"},{"key":"S0317167117000452_ref4","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-198908000-00004"},{"key":"S0317167117000452_ref9","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-198904000-00003"},{"key":"S0317167117000452_ref3","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/55.5.415"},{"key":"S0317167117000452_ref11","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181844ef2"},{"key":"S0317167117000452_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2011.11.001"},{"key":"S0317167117000452_ref18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1513721"},{"key":"S0317167117000452_ref5","doi-asserted-by":"publisher","DOI":"10.1213\/01.ANE.0000177101.99398.22"},{"key":"S0317167117000452_ref8","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199710010-00015"},{"key":"S0317167117000452_ref16","doi-asserted-by":"publisher","DOI":"10.1053\/j.trap.2008.03.002"},{"key":"S0317167117000452_ref17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1508788"},{"key":"S0317167117000452_ref6","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-198406000-00006"},{"key":"S0317167117000452_ref10","first-page":"262","article-title":"Spinal morphine for post-operative analgesia after lumbar laminectomy with fusion","volume":"86","author":"Techanivate","year":"2003","journal-title":"J Med Assoc Thailand"},{"key":"S0317167117000452_ref13","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMvcm062234"},{"key":"S0317167117000452_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/S0034-9356(10)70709-X"}],"container-title":["Canadian Journal of Neurological Sciences \/ Journal Canadien des Sciences Neurologiques"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0317167117000452","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T08:57:14Z","timestamp":1658998634000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0317167117000452\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5,8]]},"references-count":19,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2017,9]]}},"alternative-id":["S0317167117000452"],"URL":"https:\/\/doi.org\/10.1017\/cjn.2017.45","relation":{},"ISSN":["0317-1671","2057-0155"],"issn-type":[{"value":"0317-1671","type":"print"},{"value":"2057-0155","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,5,8]]}}}