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Novel method for modified interlaminar approach using contralateral oblique view: A technical suggestion.

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  • 1Department of Anesthesiology and Pain Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

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Summary

The contralateral oblique (CLO) view improves the modified interlaminar (MIL) approach for epidural access. This technique enhances safety and efficiency by reducing needle placement uncertainty.

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Area of Science:

  • Pain Management
  • Neurosurgery
  • Radiology

Background:

  • The modified interlaminar (MIL) approach aims to improve epidural space access.
  • Fluoroscopic guidance alone can leave uncertainty regarding needle tip proximity to the epidural space.

Purpose of the Study:

  • To evaluate the effectiveness and safety of incorporating the contralateral oblique (CLO) view into the MIL approach.
  • To determine if CLO view enhances epidural space identification and needle placement accuracy.

Main Methods:

  • A retrospective analysis of 29 patients undergoing the MIL approach with CLO view.
  • Needle insertion at the interlaminar opening midpoint on anteroposterior (AP) view, angled towards the target pedicle.
  • CLO view obtained by rotating the intensifier ~45 degrees to the contralateral side to confirm the ventral interlaminar line (VILL).

Main Results:

  • Successful accessibility to the ventral epidural space was achieved in 93.1% of cases.
  • No procedure-related complications were reported.
  • The CLO view facilitated easier needle entry into the epidural space.

Conclusions:

  • The CLO view significantly reduces uncertainty during the MIL approach.
  • Incorporating CLO view into the MIL technique improves procedural safety and reduces procedure time.