Cervical interlaminar epidural steroid injection (fluoroscopic guided)

Case contributed by Dr Dai Roberts

Presentation

Bilateral arm pain, multi-level foraminal narrowing on prior MRI. For guided interlaminar epidural steroid injection.

Patient Data

Age: 80 years
Gender: Female

A 22-gauge Tuohy needle has targeted and passed through the C7-T1 interlaminar space.  Images are taken in an oblique plane, both pre and post the injection of iodinated contrast which spreads along with the dorsal epidural fat in the central canal away from the needle tip.  The posterior image shows patchy spread of contrast, again in keeping with epidural spread.

Annotated CT of the cervical spine, with the arrow representing the angulation and direction of the fluoroscopy C-arm x-ray beam required to obtain the oblique images shown previously.  

Case Discussion

Cervical interlaminar epidural injections (ILESI) are performed for radicular arm pain and by some institutions are preferred to cervical transforaminal epidural steroid injections (TFESI), due to the close relationship of the neural foramen and the vertebral artery.  

Cervical ILESIs are more technically difficult than lumbar ILESIs, as in addition to a thinner epidural space and the presence of the spinal cord, often the true lateral images will be obscured by the patient's shoulders.  An oblique view can be used to overcome this and as shown can demonstrate the needle tip and contrast distribution well 1

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Case information

rID: 77352
Published: 16th May 2020
Last edited: 17th May 2020
Inclusion in quiz mode: Included
Institution: St. Paul's Hospital

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