Journal of Orthopaedics Trauma Surgery and Related Research

Journal of Orthopaedics Trauma Surgery and Related Research

An Official Journal of Polish Society of Orthopaedics and Traumatology

e-ISSN: 2449-9145

All submissions of the EM system will be redirected to Online Manuscript Submission System. Authors are requested to submit articles directly to Online Manuscript Submission System of respective journal.

Algorithm for performing cervical epidural steroid injections with contrast spread technique

Author(s): Yakov Perper*, Yuriy Ivanov and Stacy Serebnitsky

Objective: To assist pain practitioners who perform Cervical Epidural Steroid Injections (CESI) with fluoroscopy only in recognizing possible contrast medium flow scenarios and in clinical decision making based on image findings.

Methods and Results: A total of 1574 CESIs with Contrast Spread Technique (CST) were performed from August 1, 2014, to June 1, 2020, in our office. Through numerous observations and discussions, we came to some realizations that broaden our understanding of the technique. This knowledge eventually led to the creation of this algorithm and the writing of this paper. Different scenarios were illustrated with images from our practice. Special attention was given to key points of the algorithm: What might be the reasoning for the needle tip appearing to be inside the epidural space, but without a confirmatory medium flow? What is the optimal C-Arm angulation with contralateral oblique fluoroscopy? How can practitioners recognize combined epidural and vascular spread? How can physicians differentiate the epidural from the subdural spread? Description of Space of Okada was included in the algorithm as CST increases its identification. The superior articular pillars line, a hypothetical radiological landmark, was introduced in pursuit of preventing serious complications.

Limitations: Despite some theoretical and practical advantages, CST is not a time-proven method for epidural space recognition, loss of resistance is. Multicenter clinical trials are warranted for the exploration of its utility in clinical practice.

Conclusion: The ultimate goal of any injection is the safe delivery of medication to the targeted area of pathology. Utilization of contrast media for needle depth visualization, along with a knowledgeable interpretation of the fluoroscopic images, may decrease risk, improve the quality of the procedure, and enhance both patients’ and physicians’ satisfaction with fluoroscopy-guided interlaminar epidural injections.


algorithm for epidural injections, cervical epidural steroid injection, contrast spread technique, contralateral oblique fluoroscopy, superior articular pillars line, space of Okada

Select your language of interest to view the total content in your interested language

20+ Million Readerbase
Indexed in

Embase/EXPERTA MEDICA Road Directory of Open Access
Scholarly Resources
Publons MIAR GBL Ministry of Science and Higher
Index Copernicus
Google Scholar citation report
Citations : 281

Journal of Orthopaedics Trauma Surgery and Related Research received 281 citations as per Google Scholar report

Journal of Orthopaedics Trauma Surgery and Related Research peer review process verified at publons
SCImago Journal & Country Rank
Annals of Medical and Health Sciences Research Journal of Orthopaedics Trauma Surgery and Related Research a publication of Polish Society, is a peer-reviewed online journal with quaterly print on demand compilation of issues published.
Submit your Manuscript