FactFinders for Patient Safety: Minimizing risks with cervical epidural injections

Interventional Pain Medicine, 2024 · DOI: https://doi.org/10.1016/j.inpm.2024.100430 · Published: August 27, 2024

Simple Explanation

Cervical interlaminar epidural steroid injections (CILESIs) are used to treat neck and arm pain caused by nerve compression. When performing CILESIs, it is important to consider needle placement in the lower cervical spine to avoid spinal cord injury. Using real-time imaging and the right technique is also important. Before cervical transforaminal epidural steroid injections (CTFESI), reviewing imaging scans can help doctors avoid blood vessels. Contrast dye helps to detect artery injuries.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Not specified

Key Findings

1
CILESIs should be performed at C6-C7 or below to minimize the risk of spinal cord injury.
2
LF gaps are most prevalent in the midline cervical spine, necessitating a paramedian approach during CILESI.
3
Preprocedural review of cross-sectional imaging can help decrease the risk of unintended vascular events with CTFESI.

Research Summary

CILESIs should only be performed at C6-C7 or below, with C7-T1 as the preferred access point based on an anatomic review of the cervical dorsal epidural space. Spinal LF gaps are most commonly found in the midline cervical spine. The gaps most commonly involve the middle and inferior thirds of the midline interlaminar LF. If symptomatic pathology exists bilaterally or at multiple cervical levels and a cervical epidural steroid injection is offered as a treat-ment, the treating physician might consider using an interlaminar approach at C6-7 or below if anatomically feasible.

Practical Implications

Enhanced Safety Protocols

Adoption of safer injection techniques (C6-C7 or below for CILESI) and pre-procedural imaging review can decrease neurologic risks.

Informed Clinical Decision-Making

Weighing the risks/benefits of ACAP therapy cessation versus epidural hematoma risk is crucial.

Modified CTFESI Approaches

Adjusting needle trajectory based on vascular anatomy identified in preprocedural imaging may lead to decreased risk of vascular complications.

FactFinders for Patient Safety: Minimizing risks with cervical epidural injections

Simple Explanation

Key Findings

Research Summary

Practical Implications

Enhanced Safety Protocols

Informed Clinical Decision-Making

Modified CTFESI Approaches

Study Limitations

Your Feedback

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FactFinders for Patient Safety: Minimizing risks with cervical epidural injections

Simple Explanation

Key Findings

Research Summary

Practical Implications

Enhanced Safety Protocols

Informed Clinical Decision-Making

Modified CTFESI Approaches

Study Limitations

Your Feedback

Was this summary helpful?