To the Editor:—

I read with interest the report by Hatakorian et al.  1on spinal anesthesia at the cervicothoracic level. I have heard many label this a dangerous practice, along with thoracic epidural anesthesia, because of the danger of spinal cord damage. As yet, I have been unable to find an original reference source upon which such a claim is founded, despite the evidently common practice of thoracic and cervical spinal anesthesia in the early part of the 20th century, as described by Jonnesco, 2Koster, 3,4Wright, 5and others.

In their case report, Hatakorian et al.  1state that spinal anesthesia at the cervicothoracic level “is, and must remain, an exceptional procedure,” but fail to reference that claim, and the journal editors let it stand without citation. I would be gratified if the authors would be able to cite original work (i.e. , not some expert reviewer's opinion) showing the practice, when carefully performed (as by Hatakorian et al.  1), to be routinely contraindicated, thus bringing this popular notion up to at least some minimum level of evidenced-based medicine.

Hatakorian R, Robbins R, Plourde G: Spinal anesthesia at the cervicothoracic level. A nesthesiology 2001; 95: 266–8
Jonnesco T: Remarks on General spinal analgesia. B Med J 1909; 2: 1396–401
Koster H: Spinal anesthesia with special reference to its use in surgery of the head, neck and thorax. Am J Surgery 1928; 5: 554–70
Koster H, Kasman LP: Spinal anaesthesia for the head, neck, and thorax: Its relation to respiratory paralysis. SG&O 1929; 49: 617–30
Wright AD: Spinal analgesia with special reference to operations above the diaphragm. Proc R Soc Med Lond 1931; 24: 5–12