Prospective Observation of the Fluoroscopy-guided Cervical Epidural Approach Using the Contralateral Oblique View
Condition: Cervical Intervertebral Disc Disease; Cervical Spinal Stenosis; Cervical Radicular Pain; Herpes Zoster; Postherpetic Neuralgia
MeSH terms: Herpes Zoster; Spinal Stenosis; Neuralgia; Neuralgia, Postherpetic
Study type: Interventional

Summary: 
      The aim of the present study is to investigate the safety and clinical utility of
      contralateral oblique view for fluoroscopic guided cervical epidural access.
    

Detailed description: 
      A cervical epidural block is a widely used intervention to reduce pain in patients with
      cervicalgia or cervical radicular pain. To achieve a successful procedure, accurate access to
      the cervical epidural space is needed. However, careful attention is required for this
      cervical epidural procedure due to a possibility of serious complications such as spinal cord
      infarction and quadriplegia due to blood vessel damage, convulsion due to an intravascular
      drug administration, cerebral infarction due to vascular embolism, subdural or subarachnoid
      injection, hematoma, and spinal cord injury. Although the use of fluoroscopy improves the
      safety and accuracy of cervical epidural access, this technique still has significant
      drawbacks, such as false loss of resistance and difficulty in assessing the depth of the
      needle tip in lateral views in relation to the epidural space. To overcome this issue,
      cervical epidural access using the contralateral oblique (CLO) view has been introduced and
      the ideal angle of CLO view for the cervical spine is reported as 50 degrees.

      However, it has not been reported on the safety and clinical utility of using the CLO view
      during cervical epidural access. Therefore, the investigators planned this study to observe
      the safety and clinical utility of the CLO view at 50 degrees for the cervical epidural
      block.
    

Intervention name(s): Fluoroscopic-guided cervical epidural access
Intervention type(s): Procedure
Intervention description(s): After identifying the target level of the cervical spine under a fluoroscopy-guided anteroposterior image, an 18-Tuohy needle is inserted through a paramedian approach after local infiltration with 1% lidocaine. When feeling a strong resistance through the needle by a ligamentum flavum, the image intensifier is rotated to 50 degrees contralateral oblique (CLO) direction. After then, the needle is advanced to just before the ventral interlaminar line in CLO view. It is subsequently advanced further until it is in the epidural space using a LOR-to-air technique. Correct epidural access is confirmed by the injection of contrast medium. After identifying epidural space in AP and CLO view without abnormal dispersion of contrast,(vascular uptake, intrathecal spreads, etc.), a 3-4ml mixture of 0.5% lidocaine with dexamethasone 5mg is injected.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: fluoroscopy; contralateral oblique view; cervical epidural block; cervical epidural space