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CT-Guided Cervical Epidural Spinal Injection: Technique and Pitfalls 2013

Category Interventional Bob B. Chai, MD, PhD
Charles Cho, MD, MBA
Purpose Cervical epidural injection is a common non-surgical technique for treatment of oral medication-resistant chronic neck pain and radiculopathy. Serious complications from loss-of-resistance technique and fluoroscopy-guided cervical epidural injections have raised concerns over its safety. CT-guided epidural spinal injections provide direct cross-sectional visualization, increasing the operator’s confidence of needle tip location in the epidural space prior to steroid injection. We demonstrate this technique with illustration of common pitfalls. Materials & Methods Multiple patients underwent CT-guided interlaminar approach epidural spinal injection for cervical radiculopathy. Betamethasone was delivered into the epidural space using a 25-gauge spinal needle, with confirmation of needle-tip position using a small amount of contrast. Results In one patient, needle tip initially appears to be in the epidural space but contrast injection reveals its extraspinal location (Figure 1A). The needle was advanced 1-2 mm with reinjection of contrast demonstrating its epidural location (Figures 1B). In another patient, contrast surrounds the spinal cord confirming an intrathecal position of the needle tip (Figure 2A). The patient was asymptomatic. The needle was slightly retracted 1-2 mm with confirmation of epidural location after a second contrast injection (Figures 2B). Conclusion CT-guided cervical epidural spinal injection provides accurate needle tip localization and has become the standard technique in our practice, where we perform multiple spinal injections per week. We illustrate cases of technique and pitfalls where loss of resistance may not be the optimal test for needle tip location.  References Kranz PG, Raduazo P, Gray L, Kilani RK, and Hoang JK. CT Fluoroscopy-guided Cervical Interlaminar Steroid Injections: Safety, Technique, and Radiation Dose Parameters. AJNR 2012 33:1221-1224. Mentored Award Mentored Award Question 1 No Response Question 2 No Response