FACTFINDERS FOR PATIENT SAFETY: Minimizing risks with cervical epidural injections.

Area of Science:

• Pain Management
• Neurosurgery
• Radiology

Background:

• Cervical epidural steroid injections (CESI) carry risks including dural puncture, spinal cord injury, and vascular events.
• Specific techniques and patient factors influence the safety profile of both cervical interlaminar epidural steroid injections (CILESIs) and cervical transforaminal epidural steroid injections (CTFESIs).

Purpose of the Study:

• To summarize evidence and provide recommendations for minimizing risks associated with CILESIs.
• To highlight the importance of preprocedural imaging for CTFESI safety.
• To discuss safety considerations for multi-level or bilateral CTFESIs.

Main Methods:

• Review of evidence supporting specific procedural recommendations for CILESIs.
• Emphasis on anatomical landmarks and imaging techniques for safe needle placement.
• Discussion of sedation and anticoagulation management in the context of CESI.

Main Results:

• Optimal CILESI access is C7-T1 to avoid dural puncture and spinal cord injury.
• Paramedian interlaminar space needle placement is recommended to avoid ligamentum flavum gaps.
• Preprocedural imaging aids CTFESI planning to prevent vascular complications.
• Caution is advised for multi-level/bilateral CTFESIs due to potential contrast obscuration of arterial injection.

Conclusions:

• Adherence to recommended techniques and preprocedural planning can significantly reduce the risks of cervical epidural steroid injections.
• Careful patient selection, sedation management, and consideration of anticoagulation are vital for safe CESI procedures.
• Further research may be needed to fully elucidate risks associated with multi-level/bilateral CTFESIs.