Comparison of contrast flow and clinical effectiveness between a modified paramedian interlaminar approach and transforaminal approach in cervical epidural.

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Presentation transcript:

Comparison of contrast flow and clinical effectiveness between a modified paramedian interlaminar approach and transforaminal approach in cervical epidural steroid injection E. Choi, F.S. Nahm, P.-B. Lee British Journal of Anaesthesia Volume 115, Issue 5, Pages 768-774 (November 2015) DOI: 10.1093/bja/aev342 Copyright © 2015 The Author(s) Terms and Conditions

Fig 1 Approach methods of cervical epidural steroid injection. Dotted circle indicates compression of a spinal nerve root (c) by a herniated disc. 1: Interlaminar approach; 2: paramedian interlaminar approach; 3: transforaminal approach; 4: modified paramedian interlaminar approach: needle entry site is on the opposite side of the target for approach to the anterior epidural space and spinal nerve root. (a) Posterior epidural space, (b) anterior epidural space, (c) compressed spinal nerve root, (d) herniated disc, (e) posterior aspect of the intervertebral foramen. British Journal of Anaesthesia 2015 115, 768-774DOI: (10.1093/bja/aev342) Copyright © 2015 The Author(s) Terms and Conditions

Fig 2 Lateral view of grade 3 in PI group. Cervical epidural space from the spinolaminar line (dotted line, arrow) to the posterior vertebral body (posterior contour line, empty arrow) was full of contrast, more than one vertebral body level from needle entry level. If the contrast agent did not spread to the posterior contour line (empty arrow), it was considered grade 1. If the contrast agent spread to the posterior contour line at needle entry level, it was grade 2. British Journal of Anaesthesia 2015 115, 768-774DOI: (10.1093/bja/aev342) Copyright © 2015 The Author(s) Terms and Conditions

Fig 3 Anteroposterior view of grade 3 in the modified paramedian interlaminar group. Contrast spread shows spinal nerve roots of the epidural sleeve (dotted line and arrow) in the AP view, more than one vertebral body level from the needle entry level. British Journal of Anaesthesia 2015 115, 768-774DOI: (10.1093/bja/aev342) Copyright © 2015 The Author(s) Terms and Conditions

Fig 4 A Consolidated Standards of Reporting Trials (CONSORT) diagram. mPI group: patients receiving cervical epidural steroid injection by the modified paramedian interlaminar approach; TF group: patients receiving cervical epidural steroid injection by the transforaminal approach. British Journal of Anaesthesia 2015 115, 768-774DOI: (10.1093/bja/aev342) Copyright © 2015 The Author(s) Terms and Conditions