Milton H. Landers

On the geometry of fluoroscopy views for cervical interlaminar epidural injections.

OBJECTIVES To describe how the anatomy of the cervicothoracic vertebrae predicates the appropriate fluoroscopic views for confirming safe needle placement during the performance of interlaminar cervical epidural injections. METHODS AND RESULTS Illustrations, cadaver models, and radiographic images were correlated and used to illustrate and derive a mathematical model to demonstrate the utility of a contralateral oblique fluoroscopic view during the performance of cervical interlaminar injections. CONCLUSIONS When confirming needle placement during a cervical interlaminar epidural injection, in addition to the anterior-posterior fluoroscopic view, the oblique image, contralateral to the needle tip position, may provide superior information to that afforded by a lateral view.

Spinal Cord Injury During Attempted Cervical Interlaminar Epidural Injection of Steroids

Background Interlaminar cervical epidural injections are commonly performed in the practice of interventional pain medicine. Injury to the spinal cord following injection into the substance of the cord is a known complication of this procedure, but it has rarely been reported and illustrated in the literature. Objective To describe and analyze a case where an inadvertent injection of contrast medium into the cervical spinal cord occurred. Highlighted is the dissonance between how the procedure was performed and published guidelines for its performance. Presented is the first published oblique fluoroscopic image of an intramedullary injection. Conclusions By recognizing the potential complications of a procedure, and by describing means of avoiding those complications, practice guidelines serve to reduce the risk, and thereby the incidence of complications. Deviation from established best practice guidelines reinstates risks of complications that can be avoided.

Comments on: Penetration of a cervical radicular artery during a transforaminal epidural injection.

Dear Editor, As a physician who performs cervical transforaminal injections on a daily basis, I read with great interest the recent case study by Drs. Verrills, Nowesenitz, and Barnard concerning the “inadvertent” cannulation of a cervical radicular artery during the conduct of a C5-6 transforaminal injection [1]. The images of the radicular-medullary artery and its anastamoses with the anterior spinal artery are exceptional, although the small size of the pictures makes interpretation challenging. As noted by the authors, over the past decade, several dozen catastrophic complications have been reported following cervical, and lumbar, transforaminal injections. Questions have been appropriately raised as …