Korean J Pain.  2012 Jul;25(3):183-187. 10.3344/kjp.2012.25.3.183.

An Alternative Approach to Needle Placement in Cervicothoracic Epidural Injections

• Park SY
• Leem JG
• Jung SH
• Kim YK
• Koh WU

• KMID: 2278153
• DOI: http://doi.org/10.3344/kjp.2012.25.3.183

Abstract

The use of fluoroscopy guidance together with the loss of resistance technique during epidural injections has been advocated lately; moreover, epidural injections in the absence of fluoroscopic guidance have a high rate of inaccurate needle-tip placement during the injections. However, the approach to the lower cervical and upper thoracic epidural space may be challenging due to its obscure lateral fluoroscopic views from overlying normal tissue structures. In this case, we report an alternative oblique C-arm fluoroscopy guided view approach to supplement the standard anterior-posterior and lateral fluoroscopic views to facilitate successful needle placement and precise anatomical localization of the epidural space.

Keyword

alternative; epidural; fluoroscopy; oblique

MeSH Terms

Epidural Space
Fluoroscopy
Injections, Epidural
Needles

Figure

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  Fig. 1 Cisternography. Alternative and the standard lateral views under fluoroscopy. Cisternography revealed the CSF leakage at the C-C and C-T junction (A). Alternative (B) and the standard lateral views (C) were showed. Note that adequate lateral view was difficult to obtain due to normal shoulder structures.

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  Fig. 2 AP and the alternative oblique views under fluoroscopy. AP view (A) and the alternative oblique view (B) under fluoroscopy; the contralateral laminae are seen in complete cross-section view. Epidural space was confirmed with contrast dye injection (C and D). Angle of the X-ray beam was parallel to the C7 laminar plane (E). Arrow indicated a hollow tube.

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