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A New Way to Obtain Clear Lateral Fluoroscopic Pictures for Cervical Epidural Steroid Injections

For cervical interlaminar epidural steroid injection, it is often difficult to visualize the needle tip and contrast in the epidural space before the medication can be safely injected. The goal of this study was to investigate a new method that will provide a clearer lateral fluoroscopic view of the Tuohy needle tip and contrast in the cervical epidural space. A total of 105 patients were enrolled. After the Tuohy needle reached the cervical epidural space, lateral fluoroscopic pictures were taken in 2 different positions (half-shoulder, half-neck position and more-shoulder, less-neck position) with and without contrast. Clarity of the pictures was compared visually to investigate which fluoroscope position yields more clear lateral fluoroscopic view of the Tuohy needle tip and contrast in the cervical epidural space. It was found that without contrast, there was a significantly higher chance (P<0.001) to see the Tuohy needle tip in the cervical epidural space when the fluoroscope was at the more-shoulder, less-neck position (94% chance) than when the fluoroscope was at the initial half-shoulder, half-neck position (17% chance). With the contrast, it is significantly (P<0.001) more likely to see the Tuohy needle tip and contrast in the cervical epidural space (100% chance) with the fluoroscope at the more-shoulder position than when the fluoroscope was at the half-shoulder, half-neck position (32% chance). The new method of positioning fluoroscope can help obtaining clearer lateral fluoroscopic pictures of the Tuohy needle tip and contrast in the cervical epidural space, thus to enhance the accuracy and safety of cervical epidural steroid injections.