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  • Comparison of contralateral oblique view with the lateral view for fluoroscopic-guided cervical epidural steroid injection: a randomized clinical trial

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Original research
Comparison of contralateral oblique view with the lateral view for fluoroscopic-guided cervical epidural steroid injection: a randomized clinical trial
  1. Ji-Hoon Sim1,
  2. Hyun-Jung Kwon1,
  3. Chan-Sik Kim1,
  4. Eun Ha Kim1,
  5. Doo-Hwan Kim1,
  6. Seong-Soo Choi1 and
  7. Jin-Woo Shin2
  1. 1 Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
  2. 2 Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
  1. Correspondence to Professor Doo-Hwan Kim, Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Songpa-gu, Republic of Korea; dh_kim{at}amc.seoul.kr

Abstract

Background Cervical epidural steroid injection is associated with rare but potentially catastrophic complications. The contralateral oblique (CLO) view may be a safe and feasible alternative to the lateral (LAT) view for fluoroscopic-guided cervical epidural steroid injection. However, evidence for the clinical usefulness of the CLO view for cervical epidural steroid injection is lacking. We assessed the clinical usefulness of the CLO view for cervical epidural steroid injection in managing cervical herniated intervertebral discs.

Methods Patients were randomly assigned to receive fluoroscopic-guided cervical epidural steroid injection under LAT view or CLO view at 50±5° degrees groups. The primary outcome was the needling time comparison between the two groups. Secondary outcomes were comparison of first-attempt success rate, needle tip visualization and location, total number of needle passes, final success rate, crossover success rate and false-positive/negative loss of resistance. Complications and radiation dose were also compared.

Results The needling time significantly decreased in the CLO than in the LAT group. The first-attempt success rate was significantly higher in the CLO compared with the LAT group. The needle tip was clearly visualized (p<0.001) and located more often on (or just anterior to) the ventral interlaminar line (p<0.001) in the CLO than in the LAT group. There were significantly fewer needle passes (p=0.019) in the CLO than in the LAT group. There were no significant differences in the final success, crossover success, false-positive/negative loss of resistance or radiation dose between the groups. Two (5.9%) cases in the LAT group experienced complications.

Conclusion The CLO view may be recommended for fluoroscopic-guided cervical epidural steroid injection, considering its better clinical usefulness over the LAT view.

  • neck pain
  • nerve block
  • pain management
  • chronic pain

Data availability statement

Data are available upon reasonable request. Not applicable.

https://doi.org/10.1136/rapm-2021-103177

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    Data availability statement

    Data are available upon reasonable request. Not applicable.

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    Footnotes

    • Contributors J-HS: conception, design and conduct of the study; analysis and interpretation of data; reporting; and writing―original draft preparation. H-JK, C-SK, EHK: data curation and acquisition; analysis and interpretation of data. S-SC: conception, design and conduct of the study. JWS: supervision; and project administration. D-HK: planning, conception, design and conduct of the study; writing―review and editing of the manuscript; supervision; and project administration. D-HK (guarantor) accepts full responsibility for the finished work and/or the conduct of the study. All authors revised the manuscript critically for important intellectual content. All authors gave approval for the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.