Targeted Cervical Epidural Steroid injection using a radiopaque catheter- A technique report
Muhammad Khan, Ryan Zollett, David Okano, and Muhammad Munir. University of Cincinnati, Cincinnati, OH, USA
Cervical radicular pain is most commonly caused by disc herniation or foraminal stenosis. Cervical epidural steroid injections have been employed in the treatment successfully for their anti-inflammatory effects. The results of such epidural injections depend on precise deposition of steroid at the level of pathology. Cervical transforaminal approach may deliver injectate precisely to the level of pathology, however may increase risk of serious complications including stroke, paraplegia and death. We describe a novel approach with use of a radiopaque catheter to deliver injectate at the desired level via interlaminar approach without increasing risks of the procedures.
Patient is placed prone with chest roll and neck flexed. Fluoroscope is used to identify C7- T1 interlaminar space. Loss of resistance to air and saline is used to identify epidural space. After identifying epidural space a radiopaque styletted catheter is advanced towards the desired level of pathology under direct fluoroscopic guidance. The stylet is removed and non-ionic contrast is injection under continuous fluoroscopic guidance. After confirming contrast spread to the desired level of pathology steroid mixed with local anesthetic is injected. Catheter and needle are then removed after flushing with preservative free saline.
Targeted cervical epidural steroid injection may be performed safely using a radiopaque catheter. Cervical epidural steroid injection performed without a catheter may result in distribution of medication in an undesired distribution resulting in less then desired outcome. Cervical epidural steroid injection with a radiopaque catheter provides a safer alternate to cervical transforaminal injection to deliver injectate to the desired level of pathology in cervical spine.