Procedure Cervical Interlaminar Epidural Injection

Position and anatomical landmarks

Before performing cervical interlaminar epidural injection, MRI should be seriously considered in order to exclude large disc protrusions deforming the posterior epidural space.

Cervical epidural infiltrations are preferably carried out with the patient in a sitting position. The cervical spinal column is bent forwards. The skin is disinfected.

For positions C5/C6 or C6/C7, the anaesthetist places his middle and index fingers on both sides of the spinal processes. After a midline needle placement 'down the barrel', with the needle firmly fixed, the operator can switch to a lateral view and very slowly advance the needle as it approaches the base of the spinal processes, while concomitantly using a glass syringe loss of resistance or alternatively the hanging drop technique under fluoroscopic guidance. A small amount of contrast dye can be injected in order to ensure correct epidural placement of the needle using fluoroscopy (Figure 1). When the needle has been correctly inserted, a syringe containing the administration solution is attached. Aspiration is carried out carefully in order to identify cerebrospinal fluid or blood.

 

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Figure 1. Interlaminar epidural corticosteroid administration C6-C7: lateral view.

A small amount of contrast dye can be injected in order to ensure the correct epidural placement of the needle using fluoroscopy.

Procedure

When the needle has been correctly inserted, a syringe containing the administration solution is attached. Aspiration is carried out carefully in order to identify cerebrospinal fluid or blood.

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Figure 6. Anterior posterior view after injection with contrast dye. The needle and spread of the contrast dye can be seen.

Then the local anesthetic and corticosteroids are administered.

Complications

  • Dural puncture with or without transient headache.
  • Aseptic meningitis, arachnoiditis, epidural abscess.