Question
Am i able to have an epidural if necessary during child birth if i have screws in my L3/L4 vertebrae?  The L3/L4 are fused in subluxation.  I have looked for information on this with no luck.  All information about epidurals does not indicate which vertabrae the needle enters through or near.  Thankyou, Cassandra Stoeckel

Answer
Dear Cassandra,

Yes you should be able to get the epidural.  Normal placement of an epidural is usually at the L4/L5 level, so this should not be a problem.  However, the anesthesiologist always has the option to place the epidural a level higher or lower...the problem arises when the epidural needs to be placed higher in the spine, because if it is placed too high, the diaphragm can be affected, and this will cause breathing problems. there is a possibility that your OB/GYN and the anesthesiologist may elect not to place the epidural and instead place you under for a c-section, but you should discuss this with your OB/GYN before you present to the hospital in labor.

You need to consult with the anesthesia team before you present to the hospital, and discuss these issues.  It would be a good idea to make sure that you take a copy of your lumbar x-rays to be visualized while you are in Labor and Delivery.  This way it doesn't matter what anesthesiologist or certified nurse anesthetist is on rotation-as they will be able to look directly at the x-ray and understand where the hardware has been placed in the spine.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net