Cervical interlaminar epidural injection
Cervical interlaminar epidural injections are one of some possible spinal epidural injections. For an alternative approach for the same region, please refer to the article on cervical transforaminal epidural injections.
Typically epidural injections are performed in patients with radicular pain who are currently not surgical candidates.
Allergy to any of the planned medications is, of course, a contraindication, although it is possible to perform this without contrast, provided consent includes the increased risk of intravascular or intradural injection.
Local or systemic infection is also a contraindication.
Diabetic patients demand caution due to the administration of steroids, but they are not contraindicated.
Positioning/room set up
The patient should be comfortable placed prone on the fluoroscopy table, with the posterior neck and thorax exposed. A pillow is usually placed under the chest and a towel under the forehead making the patient more comfortable during the procedure.
- alcohol or iodine (or both) containing skin preparation
- fenestrated or chuck-drapes
- 22-gauge spinal needle
- isotonic contrast, e.g. 240 mg/mL iohexol
- local anesthetic, e.g. 1% lignocaine/lidocaine
- steroid, e.g. dexamethasone (non-particulate)
- long-acting local anesthetic, e.g. bupivacaine
- plan the procedure using, when possible, previous CT/MRI exams
- after patient positioning, select the needle entry and demarcate it on the skin
- on a true AP identify the level to be approached (e.g. C6/7 or C7/T1)
- mark the point located halfway down from the superior endplate of the inferior vertebral body (e.g. C7 when accessing C6/7) and halfway between the spinal process and the pedicle
- skin preparation and drapes placement
- introduce the needle and angle it towards the midline
- rotate the image 45-55 contralaterally and then progress the needle under fluoroscopy view, ~1mm at a time, and verify with a small amount of contrast until reaching the posterior epidural space
- confirm the posterior epidural space with a few milliliters of contrast injection
- inject the therapeutic mixture
As with other epidural injections, recovery in the department for 20-30 minutes minimum is recommended.
As with all epidural spinal injections, care should be taken to confirm extradural location, to avoid intradural injection with resultant adhesive arachnoiditis. A low-pressure headache can also result from dural puncture (subarachnoid tap).
Post-procedure infection is rare.
- 1. Johnson BA, Schellhas KP, Pollei SR. Epidurography and therapeutic epidural injections: technical considerations and experience with 5334 cases. AJNR Am J Neuroradiol. 1999;20 (4): 697-705. AJNR Am J Neuroradiol (full text) - Pubmed citation
- 2. McGraw JK. Interventional radiology of the spine, image-guided pain therapy. Humana Pr Inc. (2004) ISBN:1588291987. Read it at Google Books - Find it at Amazon
- 3. 4. Waldman SD. Atlas of Interventional Pain Management. Saunders. (2009) ISBN:1416099948. Read it at Google Books - Find it at Amazon
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