Optimization of the Needle Tip Position for the Proper Contrast Spread Pattern and Clinical Outcomes During Cervical...

Area of Science:

• Pain Management
• Interventional Radiology
• Neurosurgery

Background:

• Cervical transforaminal epidural steroid injection (CTFESI) is a common procedure for neck and upper extremity pain.
• Optimal needle placement is crucial for efficacy and safety, but the ideal location is debated.
• Understanding the relationship between needle tip position and contrast spread is essential for improving outcomes.

Purpose of the Study:

• To evaluate the correlation between needle tip position and contrast spread patterns during CTFESI.
• To determine the influence of needle tip position on vascular spread.
• To assess how different needle tip positions affect pain reduction.

Main Methods:

• 185 patients undergoing CTFESI for cervical disc herniation or stenosis were analyzed (287 procedures).
• Needle tip position was categorized (lateral, middle, medial third of the articular pillar).
• Contrast spread (epidural, intraforaminal, extraforaminal) and vascular spread were assessed via fluoroscopy; pain reduction (NRS) was recorded.

Main Results:

• Medial third needle tip placement significantly improved epidural contrast spread and reduced vascular spread compared to lateral placement.
• Needle placement in the medial third area resulted in significant pain reduction and improved epidural contrast flow.
• These positive outcomes were reproducible with medial third needle placement.

Conclusions:

• Positioning the needle in the medial one-third of the articular pillar during CTFESI optimizes target area access.
• This precise needle placement promotes better epidural space spread and enhances pain relief.
• Medial third needle placement is recommended for improved CTFESI outcomes.