Cervical interlaminar epidural injection

Cervical interlaminar epidural injections are one of some possible spinal epidural injections. For an alternative approach for the same region, please refer to the article on cervical transforaminal epidural injections. 

Typically epidural injections are performed in patients with radicular pain who are currently not surgical candidates. 

Allergy to any of the planned medications is, of course, a contraindication, although it is possible to perform this without contrast, provided consent includes the increased risk of intravascular or intradural injection. 

Local or systemic infection is also a contraindication.

Diabetic patients demand caution due to the administration of steroids, but they are not contraindicated. 

Positioning/room set up

The patient should be comfortable placed prone on the fluoroscopy table, with the posterior neck and thorax exposed. A pillow is usually placed under the chest and a towel under the forehead making the patient more comfortable during the procedure. 

Equipment
  • alcohol or iodine (or both) containing skin preparation
  • fenestrated or chuck-drapes
  • 22-gauge spinal needle
  • isotonic contrast, e.g. 240 mg/mL iohexol
  • local anaesthetic, e.g. 1% lignocaine/lidocaine
  • steroid, e.g. dexamethasone (non-particulate)
  • long-acting local anaesthetic, e.g. bupivacaine
  • bandaid
Technique
  1. plan the procedure using, when possible, previous CT/MRI exams
  2. after patient positioning, select the needle entry and demarcate it on the skin
    • on a true AP identify the level to be approached (e.g. C6/7 or C7/T1)
    • mark the point located halfway down from the superior endplate of the inferior vertebral body (e.g. C7 when accessing C6/7) and halfway between the spinal process and the pedicle
  3. skin preparation and drapes placement
  4. introduce the needle and angle it towards the midline 
  5. rotate the image 45-55 contralaterally and then progress the needle under fluoroscopy view, ~1mm at a time, and verify with a small amount of contrast until reaching the posterior epidural space
  6. confirm the posterior epidural space with a few millilitres of contrast injection
  7. inject the therapeutic mixture    
Postprocedural care

As with other epidural injections, recovery in the department for 20-30 minutes minimum is recommended. 

As with all epidural spinal injections, care should be taken to confirm extradural location, to avoid intradural injection with resultant adhesive arachnoiditis. A low-pressure headache can also result from dural puncture (subarachnoid tap). 

Post-procedure infection is rare. 


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Article Information

rID: 42041
Tag: cases
Synonyms or Alternate Spellings:
  • Cervical epidural interlaminar injection

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