In addition to the ability to accurately visualize the needle tip during epidural access, it is also critical to have a reliable radiological landmark to guide how far the needle can be safely inserted. Any last-second patient manipulation with a needle so close to the spinal cord is not desirable. The clinical success of these manipulations has not been evaluated. Various maneuvers such as adjusting the fluoroscope, caudad manipulation of the shoulders, and the swimmer's view have been suggested in order to improve the quality of needle tip imaging. Visualization of the needle tip in the lateral view in the lower cervical and cervicothoracic area is often impaired. The optimal use of fluoroscopy to meet this end has not been studied. It is clear that major cord injuries continue to occur, even with the use of fluoroscopy.Īccurate and precise visualization of the needle tip is critical to avoid trauma to the spinal cord. ![]() In the same study, it was reported that fluoroscopy was employed in 76% of the procedures that were associated with injury. In an American Society of Anesthesiologists closed claims analysis for cervical procedures from 2005 to 2008, there were 20 reported cases of direct spinal cord injury during interlaminar cervical epidural access. ![]() Despite the introduction of imaging technology, epidural interventions are not without risk. It is also likely to improve accuracy of needle placement. Fluoroscopy is now commonly used in clinical practice with the premise that it improves safety. The cervical and cervicothoracic epidural space is frequently accessed for therapeutic spine interventions such as an epidural steroid injection. ![]() Epidural (Injection Space), Fluoroscopy Introduction
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