Detection of Epithelial Cell Transfer in Spinal Areas by Light Microscopy and Determining Any Tissue Coring via Cell Culture During Combined Spinal-Epidural Interventions

Abstract

We could not reproduce the cells or cell debris obtained during the CSE interventions in vivo, which can be explained by a possible structural deformation of cells or the inadequacy of the amount of cells that were transferred.

Comparing tissue coring potentials of hollow needles without stylet and caudal needles with stylet

“…In accordance with our previous studies and other recently published data [6,8,9], our study failed to demonstrate transportation of stratum basale cells, which, with their proliferative potential, could produce an epidermal tumour. Only stratum corneum cells ready to desquamate from the outermost layers of the skin could be sampled during the puncture of the either needle types, and since these cells lack nuclei and are virtually dead, they have no potential to proliferate in wherever or whatever medium they may be transported to.…”

“…In several published studies, potential for tissue transport by the spinal needles was investigated after inserting and removing various types of needles [3,6,9]. It was also shown that tissue coring occurs even if the stylet is in place and an introducer needle is used [10].…”

Cerebrospinal Fluid Cytology in Patients Undergoing Combined Spinal Epidural versus Spinal Anaesthesia without an Introducer

“…It has been advocated that the introducer should also have a stylet when initially placed through the skin, in order to avoid tissue coring within the introducer 2 . In a study of CSE interventions where the spinal needle was advanced through the epidural needle, epithelial cells were detected on the outer surface of the epidural needle in 33.3% of cases and in the internal washings of the epidural needle in 26.7% of cases 20 .…”

“…Tunali and colleagues conducted a study to detect epithelial cell transfer in patients undergoing CSE interventions. Using a cytocentrifuge method, they analysed the CSF and spinal and epidural needle washings for epithelial cells and detected them in the CSF of 6.9% of the study patients 20 . Various other studies have reported an incidence of tissue coring of 15 to 80% after examining the tips and the shafts of the used spinal needles 1,2,18,19 .…”

“…Though the use of an introducer avoids direct contact between the skin and the spinal needle, the introducer itself may also core tissue 2 . The epithelial cells near the bevel and the distal opening of the introducer needle could then be transmitted to the tip of the advancing spinal needle and later transferred to the subarachnoid space and circulating CSF 20 . In our study, the higher number of epithelial cells in CSF noted with the CSE technique was not significant and may have been due to chance.…”