Fluoroscopic contralateral oblique view in interlaminar interventions: a technical note

To describe the value and utility in using a contralateral oblique (CLO) view when performing cervical, thoracic, and lumbar interlaminar procedures including epidural steroid injections and spinal cord stimulation percutaneous lead placement.

Fluoroscopic images are used to illustrate the value of using CLO views. The CLO view is obtained after the level is confirmed. Then, the fluoroscope is obliqued contralateral to the needle tip to visualize the target interlaminar space and the spinolaminar line. In this fluoroscopic setup, the needle can be seen traversing between the superior and inferior lamina (elliptical appearing structures on CLO view) with the needle tip directed toward the spinolaminar line. The needle is then advanced through the ligamentum flavum into the posterior epidural space. The CLO view helps better visualize needle tip placement when patient positioning, body habitus, or other atypical anatomy makes visualization in standard lateral views challenging. The CLO provides more consistent visualization of the target structures.

We recommend that the CLO view for thoracic and lumbar interlaminar procedures, in addition to cervical cases. Thus, when confirming proper needle placement for interlaminar procedures, the CLO view combined with anterior-posterior view yields safe multi-planar imaging and should be considered when a lateral view is unable to demonstrate target landmarks clearly.