Contrast Flow Characteristics in the Cervical Epidural Space

Goel, Ashish; Pollan, Jennifer J

doi:10.1097/01.brs.0000222020.45794.ac

Cited by 56 publications

(33 citation statements)

References 4 publications

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“…7,31,89,90 Furthermore, to minimize the chance of a dural puncture, it is wise to perform ICESI at C7-T1 33 or at the highest, C6 -C7, as the epidural space is the largest in this area. 36 In addition, MRI should be obtained to ensure adequate space within the spinal canal of the level to be injected. If significant constriction is present at the level of pathology, ICESI should be performed at the level below or avoided completely.…”

Section: Discussionmentioning

confidence: 99%

Complications of Interlaminar Cervical Epidural Steroid Injections

Abbasi¹,

Malhotra²,

Malanga³

et al. 2007

Spine

124

103

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There are significant limitations in the available literature discussing the complications associated with ICESI, but they strongly suggest that ICESI is a relatively safe procedure. Numerous potential adverse reactions have been associated with ICESI, with the vast majority being minor and transient in nature. However, serious complications may also result and may be technique related. Injectionists should be aware of the clinical presentations, rates, potential consequences, and appropriate techniques to avoid these complications. More studies are needed with specific focus on cervical complication rates, standardization of injection techniques, and differentiation between complications and poor efficacy. In addition, the use of a prospective randomized blinded controlled design would be beneficial.

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Section: Discussionmentioning

confidence: 99%

Complications of Interlaminar Cervical Epidural Steroid Injections

Abbasi¹,

Malhotra²,

Malanga³

et al. 2007

Spine

124

103

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“…[ 12 15 16 ] Yokoyama et al [12] showed that the contrast pattern is useful for predicting the distribution of local anesthetics. Other studies have shown that a 2 to 4 mL volume is adequate for contrast spread throughout the entire cervical epidural space, bilaterally.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have shown that a 2 to 4 mL volume is adequate for contrast spread throughout the entire cervical epidural space, bilaterally. [ 15 16 ] In 1 study, a 5 mL volume was found to be optimal for distribution to the lower cervical spine in degenerative cervical spinal diseases [14] . However, these studies had some limitations.…”

Section: Discussionmentioning

confidence: 99%

“…There have been few studies on the relationship between the volume of solution and the cephalad spread of solution in CIEIs. [ 14 16 ] Moreover, most lesion sites associated with neck and upper-extremity pain are in the ventral epidural space [3] . Therefore, it is important to identify the optimal volume of medication to use for appropriate spread to ventral epidural space at the lesion level when performing CIEIs [3] .…”

Section: Introductionmentioning

confidence: 99%

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Optimal volume of injectate for fluoroscopy-guided cervical interlaminar epidural injection in patients with neck and upper extremity pain

et al. 2016

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There is no study of optimal volume of contrast medium to use in cervical interlaminar epidural injections (CIEIs) for appropriate spread to target lesions. To determine optimal volume of contrast medium to use in CIEIs. We analyzed the records of 80 patients who had undergone CIEIs. Patients were divided into 3 groups according to the amount of contrast: 3, 4.5, and 6 mL. The spread of medium to the target level was analyzed. Numerical rating scale data were also analyzed. The dye had spread to a point above the target level in 15 (78.9%), 22 (84.6%), and 32 (91.4%) patients in groups 1 to 3, respectively. The dye reached both sides in 14 (73.7%), 18 (69.2%), and 23 (65.7%) patients, and reached the ventral epidural space in 15 (78.9%), 22 (84.6%), and 30 (85.7%) patients, respectively. There were no significant differences of contrast spread among the groups. There were no significant differences in the numerical rating scale scores among the groups during the 3 months. When performing CIEIs, 3 mL medication is sufficient volume for the treatment of neck and upper-extremity pain induced by lower cervical degenerative disease.

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“…21 However, it has never been claimed that neck-flexion angle affects contrast spread. 23 In one study, it was suggested that an anterior shift of the posterior aspect of the dura during neck flexion probably results in a transient negative pressure in the posterior spinal canal, and consequently increases venous volume within the posterior epidural venous plexus, 24 which we believe could increase CEP.…”

Section: Discussionmentioning

confidence: 99%

Cervical Epidural Pressure Measurement

et al. 2010

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Background:The hanging drop technique is used for identifying the cervical epidural space, using its negative pressure. However, it is doubtful whether the epidural space intrinsically exhibits a negative pressure. We designed this study to test the hypothesis that the cervical epidural pressure (CEP) is significantly higher in the prone position than in the sitting position. To evaluate this hypothesis, we measured and compared 30 CEP values in the prone and sitting positions. Methods: We measured and compared 15 CEPs in the prone group and 15 in the sitting group using a closed pressure measurement system under fluoroscopic guidance. Results: All CEPs in the prone group were consistently positive (median, 10 mmHg; range, 4.8 -18.7; mean Ϯ SD, 10.5 Ϯ 4.4) in contrast to the sitting group (median, Ϫ0.3 mmHg; range, Ϫ2.4 -7.9; mean Ϯ SD, 0.5 Ϯ 2.8). CEPs in the prone group were significantly higher than in the sitting group (P Ͻ 0.001). Conclusion: CEP was found to be significantly higher in the prone position than in the sitting position. Furthermore, CEPs were not consistently negative even in the sitting position. These results suggest that the hanging drop technique is inappropriate for identifying the cervical epidural space in either the prone or sitting positions. CERVICAL epidural steroid injections (CESIs) are used worldwide for the conservative management of head, neck, and upper extremity pain.1-3 When performing CESIs, proper identification of the epidural space is imperative to minimize the risk of dural puncture, which is associated with potentially catastrophic complications, such as permanent spinal cord injury. 4 -7 To identify the cervical epidural space, practitioners occasionally use the hanging drop (HD) technique, 8 which identifies the epidural space using its negative pressure. However, it is doubtful whether the epidural space intrinsically exhibits a negative pressure. In previous studies, in which closed pressure measurement systems were used, 10 -12 epidural pressure (EP) was commonly found to be positive at the thoracic level in the lateral decubitus position and to be consistently negative only in the sitting position.10 These results suggest that EP is influenced by body position, and that patients should be seated when the HD technique is used. However, to our knowledge, no report or peer-reviewed article has been conducted on the topic of cervical epidural pressure.Accordingly, we designed this study to test the hypothesis that CEP is significantly higher in the prone position than in the sitting position. To evaluate this hypothesis, we measured

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Contrast Flow Characteristics in the Cervical Epidural Space

Cited by 56 publications

References 4 publications

Complications of Interlaminar Cervical Epidural Steroid Injections

Complications of Interlaminar Cervical Epidural Steroid Injections

Optimal volume of injectate for fluoroscopy-guided cervical interlaminar epidural injection in patients with neck and upper extremity pain

Cervical Epidural Pressure Measurement

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