경부 후경막외강 C자형 영상증강장치 유도하 판간접근법 시 반대측 사위상의 최적각도

Abstract

Background : The contralateral oblique (CLO) view is superior to the lateral view in visualizing the needle tip and may improve overall safety when performing cervical interventions via the posterior epidural space. The aim of this study was to investigate an optimal CLO angle for cervical epidural steroid injection using the fluoroscopically guided interlaminar approach.

Methods : The CLO angle for optimal entry into the epidural space was measured at C4, C5, C6, and C7 segmental levels using cross-sectional cervical spine magnetic resonance imaging scans. A total of 300 MRI scans were analyzed, including 159 men and 141 women, with ages ranging from 13 to 85 years old. The axial images of MRI scan were used to measure the optimal CLO angle. The angles were taken bilaterally at levels of C4, C5, C6, and C7. The average angle between the patient’s left and right side was calculated.

Results : In both men and women, the mean CLO angle (in degrees) with standard deviation measured in the 300 MRI scans at C4, C5, C6, and C7 were 53.3 ± 3.3 ˚, 52.1 ± 3.3 ˚, 50.4 ± 3.6 ˚ and 49.5 ± 3.8 ˚, respectively. There were statistically significant differences among each segmental level (P<0.05 in 6 comparison between 4 groups in ANOVA with bonferonni correction). Also, there were statistically significant differences between male and female in the ∠C5 and ∠C7. However, There were no statistically significant differences between age groups.

Conclusions : This is the first study investigating the CLO angle for performing cervical ESIs using the fluoroscopically guided interlaminar approach. Based on the patient population of 300, the mean optimal CLO angle using the posterior interlaminar approach appears to be between the range of 37.5 ˚ to 66.5 ˚ ( median 51.3 ˚ ) degrees with an average of slightly more than 50 degrees. Further research with initial fluoroscopic alignment of approximately 50 degrees in posterior epidural interlaminar approach is warranted to confirm the usefulness of these findings.