19 Harley St, London, W1G 9QJ, UK

Contrast flow characteristics in the cervical epidural space: an analysis of cervical epidurograms

STUDY DESIGN: A single-center prospective analysis of cervical epidurograms, using a crossover design. OBJECTIVES: To delineate the extent and pattern of spread of epidural contrast during cervical epidural steroid injections. To determine the volume of solution needed for effective cervical epidural steroid injections. To determine the most appropriate neck flexion angles for cervical epidural steroid injections. To determine the relationships between epidural spread, degree of neck flexion, and volume of solution used during cervical epidural steroid injections. SUMMARY OF BACKGROUND DATA: The decreased epidural space in the cervical region makes injections here liable to rare, but potentially serious, complications. The lower cervical (C6-C7, C7-T1) levels are thought to be safer because of the increased epidural space here, as compared with higher levels. There is, however, considerable controversy in the scientific literature regarding the levels at which cervical epidural injections should be performed. There is also no consensus regarding the volume of solution needed or the extent of neck flexion required for effective epidural spread. To date, no study has examined these questions. METHODS: Patients with lower cervical spine pathology who were referred for cervical epidural steroid injections were randomly assigned to have the injections performed at the C6-C7 or C7-T1 midline level. Volume of solutions used and degree of neck flexion were measured. Characteristics of epidural spread were recorded. Patients requiring repeat injections had the injections performed at the adjacent level with identical volume and angle of neck flexion using a goniometer. Contrast flow characteristics were again recorded. Extent of spread was correlated with the level of injection, volume of injectant, and degree of neck flexion. RESULTS: No major or permanent complications were noted. The contrast was found to spread evenly throughout the entire dorsal cervical epidural space, on a consistent basis, in all cases. At C6-C7, it was found to spread an average of 3.61 +/- 0.84 levels; and at C7-T1, it spread an average of 3.88 +/- 1.01 levels. Using a three-way analysis of variance, the level at which the epidural was performed, the amount of contrast used, and the neck flexion angle did not affect the number of levels spread. CONCLUSIONS: In cervical epidural steroid injections performed in the midline at C6-C7 and C7-T1, the contrast consistently covers the dorsal cervical epidural space bilaterally, irrespective of the volume used or neck flexion angle used. This suggests that solutions introduced here would cover the dorsal cervical epidural space. This questions the utility of performing potentially more dangerous injections at higher cervical levels or more invasive procedures, such as the use of epidural catheters

Keywords : administration & dosage,analysis,Analysis of Variance,Catheters,Cervical Vertebrae,complications,Contrast Media,diagnostic imaging,drug therapy,Epidural Space,Humans,Injections,metabolism,methods,Neck,Orthopedics,pathology,Patients,pharmacokinetics,physiopathology,Prospective Studies,Radiography,Solutions,Spinal Diseases,Spine,Steroids,therapeutic use,, Flow,Characteristics,Cervical, what is a deep muscle massage

Date of Publication : 2006 Jun 15

Authors : Goel A;Pollan JJ;

Organisation : Department of Orthopedics, Wichita Clinic, Wichita, KS 67208, USA. AmitGoel@pol.net

Journal of Publication : Spine (Phila Pa 1976 )

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/16778691

The London Spine Unit : Harley Street UK. Specialists in Cutting Edge Technologies for Spinal Surgery

Make an Appointment 

Trustpilot Reviews
Doctify Reviews
Top Doctor Reviews

A unique approach to fixed occipito-cervico-thoracic deformity | Frozen shoulder heat or ice

What our patients say ...

Consultant Spine Surgeon
Consultant Spine Surgeon
Consultant Spine Surgeon

This surgical technique consists of a percutaneous approach for the treatment of small to medium size hernias of the intervertebral disc by laser energy. The main objective is to reduce the intradiscal pressure in the nucleus pulposus

Laser Disc Surgery can be performed under local anaesthetic as a day case at our centre on the prestigious Harley Street.
What is London spine unit and How it Works

The London Spine Unit was established in 2005 and has successfully treated over 5000 patients. All conditions are treated.

treatment of all spinal disorders

The London Spine Unit specialises in Minimally Invasive Treatments allowing rapid recovery and return to normal function

Trusted by patients worldwide

The London Spine Unit provides the highest quality care to all patients and has VIP services for those seeking exceptional services

If you have any emergency Doctor’s need, simply call our 24 hour emergency

Your personal case manager will ensure that you receive the best possible care.

Call Now 

+44 844 589 2020
+44 203 973 8810