CT Fluoroscopy-Guided Cervical Interlaminar Steroid Injections: Safety, Technique, and Radiation Dose Parameters

Kranz, Peter G.; Raduazo, P.; Gray, Linda; Kilani, Ramsey K.; Hoang, Jenny K.

doi:10.3174/ajnr.a2954

Cited by 30 publications

(21 citation statements)

References 19 publications

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“…A single case of thecal sac penetration was identified, which had occurred during an injection at the C5–C6 level. [35].…”

Section: Discussionmentioning

confidence: 99%

“…This resulted in a procedure time of approximately 5 minutes, which seems very fast. In literature there is a wide range of procedure times reported for CSNRB, ranging from 6 to 19 minutes for CT fluoroscopy-guided techniques [35], [37]. Nevertheless, it is very difficult to compare procedure times with this trial, as it surely was performed in an ex-vivo lamb model.…”

Section: Discussionmentioning

confidence: 99%

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Laser-Guided Cervical Selective Nerve Root Block with the Dyna-CT: Initial Experience of Three-Dimensional Puncture Planning with an Ex-Vivo Model

Freundt

Ritter²,

Al-Zghloul³

et al. 2013

PLoS ONE

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BackgroundCervical selective nerve root block (CSNRB) is a well-established, minimally invasive procedure to treat radicular cervical pain. However, the procedure is technically challenging and might lead to major complications. The objective of this study was to evaluate the feasibility of a three-dimensional puncture planning and two-dimensional laser-guidance system for CSNRB in an ex-vivo model.MethodsDyna-CT of the cervical spine of an ex-vivo lamb model was performed with the Artis Zee® Ceiling (Siemens Medical Solutions, Erlangen, Germany) to acquire multiplanar reconstruction images. 15 cervical nerve root punctures were planned and conducted with the syngo iGuide® laser-guidance system. Needle tip location and contrast dye distribution were analyzed by two independent investigators. Procedural, planning, and fluoroscopic time, tract length, and dose area product (DAP) were acquired for each puncture.ResultsAll 15 punctures were rated as successful with 12 punctures on the first attempt. Total procedural time was approximately 5 minutes. Mean planning time for the puncture was 2.03 (±0.39) min. Mean puncture time was 2.16 (±0.32) min, while mean fluoroscopy time was 0.17 (±0.06) min. Mean tract length was 2.68 (±0.23) cm. Mean total DAP was 397.45 (±15.63) µGy m2.ConclusionCSNRB performed with Dyna-CT and the tested laser guidance system is feasible. 3D pre-puncture planning is easy and fast and the laser-guiding system ensures very accurate and intuitive puncture control.

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“…A single case of thecal sac penetration was identified, which had occurred during an injection at the C5–C6 level. [35].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Laser-Guided Cervical Selective Nerve Root Block with the Dyna-CT: Initial Experience of Three-Dimensional Puncture Planning with an Ex-Vivo Model

Freundt

Ritter²,

Al-Zghloul³

et al. 2013

PLoS ONE

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show abstract

“…A CLO view (vs. lateral view) may provide more clarity and thus better safety in terms of gauging needle tip depth (relative to posterior epidural space and spinal cord) . CT guidance is advantageous for high‐level access, with less risk of complications . The purpose of this investigation was to evaluate technical success and procedural risk in patients subjected to image‐guided CESI, comparing CT, c‐arm fluoroscopy CLO, and c‐arm fluoroscopy APL approaches to visualization.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Contralateral Oblique Fluoroscopy‐guided Cervical Interlaminar Steroid Injections

Park

Lee

2015

Pain Practice

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“…2 Generally it is believed that accidental injection of the particle steroid into the radicular artery and/or spasm of the radicular artery caused the infarction of the spinal cord. 4,5 The major technical difficulty of performing a CESI is that most of the times it is difficult to see the Tuohy needle tip in the cervical epidural space, [6][7][8] and sometimes even the contrast, in a lateral fluoroscopic view (Fig. Cases of direct injection into the cervical spinal cord and subsequent paralysis have been reported.…”

mentioning

confidence: 99%

A New Way to Obtain Clear Lateral Fluoroscopic Pictures for Cervical Epidural Steroid Injections

Zhou¹,

Zhou²

2013

Techniques in Orthopaedics

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For cervical interlaminar epidural steroid injection, it is often difficult to visualize the needle tip and contrast in the epidural space before the medication can be safely injected. The goal of this study was to investigate a new method that will provide a clearer lateral fluoroscopic view of the Tuohy needle tip and contrast in the cervical epidural space. A total of 105 patients were enrolled. After the Tuohy needle reached the cervical epidural space, lateral fluoroscopic pictures were taken in 2 different positions (half-shoulder, half-neck position and more-shoulder, less-neck position) with and without contrast. Clarity of the pictures was compared visually to investigate which fluoroscope position yields more clear lateral fluoroscopic view of the Tuohy needle tip and contrast in the cervical epidural space. It was found that without contrast, there was a significantly higher chance (P < 0.001) to see the Tuohy needle tip in the cervical epidural space when the fluoroscope was at the more-shoulder, less-neck position (94% chance) than when the fluoroscope was at the initial half-shoulder, half-neck position (17% chance). With the contrast, it is significantly (P < 0.001) more likely to see the Tuohy needle tip and contrast in the cervical epidural space (100% chance) with the fluoroscope at the more-shoulder position than when the fluoroscope was at the half-shoulder, half-neck position (32% chance). The new method of positioning fluoroscope can help obtaining clearer lateral fluoroscopic pictures of the Tuohy needle tip and contrast in the cervical epidural space, thus to enhance the accuracy and safety of cervical epidural steroid injections.Key Words: cervical epidural steroid injection-fluoroscope-patient safety-neck pain and lateral view. (Tech Orthop 2013;28: 44-49) From the

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CT Fluoroscopy-Guided Cervical Interlaminar Steroid Injections: Safety, Technique, and Radiation Dose Parameters

Cited by 30 publications

References 19 publications

Laser-Guided Cervical Selective Nerve Root Block with the Dyna-CT: Initial Experience of Three-Dimensional Puncture Planning with an Ex-Vivo Model

Laser-Guided Cervical Selective Nerve Root Block with the Dyna-CT: Initial Experience of Three-Dimensional Puncture Planning with an Ex-Vivo Model

Feasibility of Contralateral Oblique Fluoroscopy‐guided Cervical Interlaminar Steroid Injections

A New Way to Obtain Clear Lateral Fluoroscopic Pictures for Cervical Epidural Steroid Injections

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