Direct Visualization of Cervical Interlaminar Epidural Injections Using Sonography

Area of Science:

• Pain Management
• Radiology
• Neurosurgery

Background:

• Conventional cervical epidural steroid injections often rely on the loss-of-resistance method for epidural space identification.
• This technique can be challenging and may lead to complications.

Observation:

• A novel ultrasound (US)-guided cervical interlaminar epidural steroid injections (CILESIs) procedure was developed.
• The technique involves identifying three US-visible structures: the interspinal ligament, ligamentum flavum, and dura mater (triple bar sign).
• Injectants were monitored using superb microvascular imaging.

Findings:

• The US-guided CILESIs procedure was successfully demonstrated in nine cases.
• This sonographic approach eliminates the need for the loss-of-resistance method.
• Direct visualization via sonography allows for easier and safer cervical epidural injections.

Implications:

• Ultrasound guidance offers a potentially safer and more accessible method for cervical epidural injections.
• This technique may facilitate outpatient cervical epidural injection procedures.
• Sonography can improve the precision and safety of epidural steroid delivery in the cervical spine.