Dural Tug is also referred to as Flexion Rotation, the act of pulling the dura that is stuck to the foramen magnum in order to open up lateral runoff. This downward rotation of the head and neck, from right to left, pulls the dura and allows the neural foramen to get larger. Moving the head forward is not enough; the downward rotation must be performed for lateral runoff to occur.
The act of flexion rotation allows the superior part of the facet joint to slide over the inferior part, making the radius bigger which allows for fluid to more easily run-off. If the patient is experiencing pain from a subdural compression, having the patient do the Dural Tug motion allows fluid to escape through the transforaminal opening. This is the main hazard area where you may encounter spinal cord stimulators and other hardware.
When a patient says, “I’m experiencing numbness” during a procedure and it is not from the anesthesia, it can be gravely hazardous. Any numbness that comes after the procedure could be coming from interference with blood supply or subdural placement that can lead to loculation. When this occurs, Dural Tug can help in two ways: First, it allows for transforaminal run-off of fluid; secondly, you move the dura, milking the subdural collection of fluid and distribute the forces that are compressing the spinal cord.
Note that more than one event can be taking place at the same time.
If you encounter a subdural injection in the cervical, thoracic, or lumbar area, have the patient begin the flex and rotation movement immediately. Dural Tug allows you the time to get a lateral view of the situation and to put a needle in the subdural space and aspirate it.
Steps Dr. Racz suggests to take in the case of a subdural injection:
Put in 10cc Saline
Take out 10cc
And repeat this process again until you dilute the subarachnoid space
*When in the subarachnoid space, the more rapid the onset, the more you will need to withdraw and to dilute the solution.
Discover why so many clinicians use the blunt needle for atraumatic access to nerve blocks, sleeve blocks, deep muscle blocks, hypogastric, paravertebral blocks, joint blocks, facets, selective nerve root, lumbar sympathetic, thoracic sympathetic, splanchnic, and celiac plexus blocks.