Comparison of contralateral oblique view with the lateral view for fluoroscopic-guided cervical epidural steroid injection: a randomized clinical trial

2021 ◽  
pp. rapm-2021-103177
Author(s):  
Ji-Hoon Sim ◽  
Hyun-Jung Kwon ◽  
Chan-Sik Kim ◽  
Eun Ha Kim ◽  
Doo-Hwan Kim ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Success Rate ◽  
False Positive ◽  
Steroid Injection ◽  
Intervertebral Discs ◽  
Epidural Steroid Injection ◽  
Clinical Usefulness ◽  
Oblique View ◽  
Loss Of Resistance ◽  
Epidural Steroid

BackgroundCervical epidural steroid injection is associated with rare but potentially catastrophic complications. The contralateral oblique (CLO) view may be a safe and feasible alternative to the lateral (LAT) view for fluoroscopic-guided cervical epidural steroid injection. However, evidence for the clinical usefulness of the CLO view for cervical epidural steroid injection is lacking. We assessed the clinical usefulness of the CLO view for cervical epidural steroid injection in managing cervical herniated intervertebral discs.MethodsPatients were randomly assigned to receive fluoroscopic-guided cervical epidural steroid injection under LAT view or CLO view at 50±5° degrees groups. The primary outcome was the needling time comparison between the two groups. Secondary outcomes were comparison of first-attempt success rate, needle tip visualization and location, total number of needle passes, final success rate, crossover success rate and false-positive/negative loss of resistance. Complications and radiation dose were also compared.ResultsThe needling time significantly decreased in the CLO than in the LAT group. The first-attempt success rate was significantly higher in the CLO compared with the LAT group. The needle tip was clearly visualized (p<0.001) and located more often on (or just anterior to) the ventral interlaminar line (p<0.001) in the CLO than in the LAT group. There were significantly fewer needle passes (p=0.019) in the CLO than in the LAT group. There were no significant differences in the final success, crossover success, false-positive/negative loss of resistance or radiation dose between the groups. Two (5.9%) cases in the LAT group experienced complications.ConclusionThe CLO view may be recommended for fluoroscopic-guided cervical epidural steroid injection, considering its better clinical usefulness over the LAT view.

Cervical epidural hematoma following interlaminar epidural steroid injection via the contralateral oblique view in patient taking omega-3 fatty acids

2019 ◽  
Vol 44 (2) ◽  
pp. 253-255 ◽  
Author(s):  
Drew Beasley ◽  
Johnathan H. Goree
Keyword(s):  
Fatty Acids ◽  
Epidural Hematoma ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Oblique View ◽  
Anti Inflammatory ◽  
Interlaminar Epidural Steroid Injection ◽  
Epidural Steroid

Background and objectivesWe sought to describe a case of an epidural hematoma after a cervical interlaminar epidural steroid injection (ILESI) performed using contralateral oblique view. We also discuss factors that could have placed this patient at increased risk, including concurrent use of omega-3 fatty acids and non-steroidal anti-inflammatory medications.Case reportA 74-year-old woman returned to the pain clinic, within 15 min of discharge, after an apparent uncomplicated cervical ILESI using the contralateral oblique technique with severe periscapular pain and muscle spasms. Cervical MRI showed a large epidural hematoma which was subsequently emergently evacuated. On postoperative examination, the patient had no neurologic deficits and full resolution of her painful symptoms.ConclusionsTo our knowledge, this is the first reported case of cervical epidural hematoma in which the contralateral oblique technique was used. Also, this is the second case in which the combination of non-steroidal anti-inflammatory medications and omega-3 fatty acids has been considered as a contributor to increased hematoma risk. This case underscores the risk of epidural hematoma using a novel fluoroscopic technique and the need for potential discontinuation of supplements like omega-3 fatty acids.

scholarly journals Lumbar Epidural Steroid Injection: Is the Success Rate Predictable?

2011 ◽  
Vol 23 (4) ◽  
pp. 147-152 ◽  
Author(s):  
Alihan Derincek ◽  
Evren Eker ◽  
Aysin Pourbagher ◽  
Murat Bekir Cinar ◽  
Metin Ozalay
Keyword(s):  
Success Rate ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Epidural Steroid

scholarly journals Severe Scapular Pain Following Unintentional Cervical Epidural Air Injection

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. E511-E514 ◽  
Author(s):  
Randall W. Henthorn
Keyword(s):  
Epidural Space ◽  
Spinal Canal ◽  
Steroid Injection ◽  
Muscle Relaxation ◽  
Epidural Steroid Injection ◽  
Air Injection ◽  
Contrast Injection ◽  
Intravenous Diazepam ◽  
Loss Of Resistance ◽  
Epidural Steroid

This a unique case of severe scapular pain following unintentional epidural space air injection during epidural steroid injection. A 70-year-old woman presented for a fluoroscopically guided C7-T1 interlaminar epidural steroid injection. Three injection attempts were made using the loss of resistance with air technique. On the first attempt the epidural space was entered, but contrast injection showed that the needle was intravenous. On the second attempt an equivocal loss of resistance with air was perceived and 5 mL of air was lost from the syringe. The needle was withdrawn and redirected, and upon the third needle passage the contrast injection showed appropriate epidural space filling up to the C4-5 level. Injection of betamethasone mixed in lidocaine was initially uneventful. However, 20 minutes post-injection the patient experienced sudden sharp and continuous pain along the medial edge of the scapula. After failing to respond to multiple intravascular analgesics, the patient was transferred to the emergency room. Her pain subsided completely following an intravenous diazepam injection. Cervical spine computerized tomography showed obvious air in the posterior epidural space from C4-5 to C6-7 as well as outside the spinal canal from (C4-T2). Having recovered fully, she was discharged the following morning. In reviewing the procedure, the equivocal loss of resistance on the second passage was actually a true loss of resistance to epidural space and air was unintentionally injected. Surprisingly, severe scapular pain resulted in a delayed manner after the steroid solution was injected. The authors theorize that unintentional prefilling of the epidural space with air prior to the injection of the subsequent steroid mixture added sufficient pressure to the epidural space to cause right-sided C4 nerve root stretching/entrapment and ensuing radicular pain to the right scapular border. The subsequent intravenous diazepam provided cervical muscle relaxation and facilitated foramina passage of air out of the spinal canal. This case demonstrates that under certain conditions entry of air into cervical epidural space can lead to unexpected, albeit temporary, neurological symptoms. Key Words: Pheumorrhacis, cervical, epidural, steroid, complication, pain, radiucular, air

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