Clinical note
Intravascular Uptake During Fluoroscopically Guided Cervical Interlaminar Steroid Injection at C6-7: A Case Report

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Abstract

Kaplan MS, Cooke J, Collins JG. Intravascular uptake during fluoroscopically guided cervical interlaminar steroid injection at C6-7: a case report.

We report 4 cases of intravascular venous uptake of contrast material during fluoroscopically guided cervical interlaminar epidural steroid injection at the C6-7 level. The blood vessel probably involved is the posterior internal vertebral venous plexus, which drains the interlaminar space and returns blood to the right atrium through the paired vertebral veins and right and left brachiocephalic veins. In all 4 cases, intravascular uptake occurred despite negative aspiration of blood before the contrast material was injected. All patients were successfully injected at the C7-T1 level. We recommend the use of fluoroscopic guidance and the injection of contrast to identify potential placement of the injection needle within the vascular space. Potential complications of intravascular venous uptake of contrast material and steroid solution are discussed.

Section snippets

Procedure Description

We used a down the barrel, hanging drop technique in all 4 cases. The patient was placed in a prone position with the neck flexed and the chest supported with a pillow to give greater access to the cervical interlaminar space. We determined the skin entry point by placing a curved metal hemostat on the patient’s skin surface and then aligning the tip of the hemostat with the target interspace. Local anesthesia was administered with a bent, 1.5-in, 25-gauge needle. The needle was removed and

Discussion

This case series describes the intravascular spread of contrast we observed when performing interlaminar ESIs at the C6-7 level in 4 patients. The technical issues raised by this finding include determining which vessels are involved, how one can avoid penetrating them when using the interlaminar approach, and how useful as a predictive tool is negative aspiration of blood for intravascular needle placement. The clinical consideration is whether there are any potential adverse effects of direct

Conclusions

With the increasing popularity of the interlaminar approach in cervical steroid injection, it is reasonable to assume that intravascular uptake will occur with greater frequency. The low sensitivity and poor negative predictive value of negative aspiration of blood in potential intravascular uptake calls for the use of fluoroscopy techniques, including the administration of contrast, to guide the correct placement of the needle. The risks of adverse sequelae resulting from venous intravascular

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