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21KF-044
Comparison of Contralateral Oblique View with Lateral View for Fluoroscopic-guided Cervical Epidural Steroid Injection
Juhan Mun, Ji-Hoon Sim, Hyun-jung Kwon, Chan-Sik Kim, Eun Ha Kim, Doo Hwan Kim, Seong-Soo Choi, Jin-Woo Shin

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

ABSTRACT
Background: Cervical epidural steroid injection is associated with rare but potentially catastrophic complications. The contralateral oblique view may be a safe and feasible alternative to the lateral view for fluoroscopic-guided cervical epidural steroid injection. However, evidence for the contralateral oblique view’s clinical usefulness for cervical epidural steroid injection is lacking. We assessed the contralateral oblique view’s clinical usefulness 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 the lateral (LAT group) or contralateral oblique view (CLO group). The primary outcome was the needling time comparison between the 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. The complications and radiation dose were also compared.
Results: The needling time significantly decreased in the CLO compared to the LAT group. The first attempt success rate was significantly higher in the CLO compared to the LAT group. The needle tip was clearly visualized (P<0.001), and located more on (or just anterior to) the ventral interlaminar line (P<0.001) in the CLO than in the LAT group. The total number of needle passes (P=0.019) were significantly decreased in the CLO than in the LAT group. No significant differences in the final success, crossover success, false-positive/negative loss of resistance and radiation dose between the groups. Two (5.9%) cases in the LAT group experienced complications.
Conclusion: The contralateral oblique view may be recommended for fluoroscopic-guided cervical epidural steroid injection, considering its better clinical usefulness over the lateral view.

REFERENCES
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