Head Pain, Neck Pain, Upper Extremity Pain
Conditions
Keywords
cervical, epidural, epidural pressure, monitoring
Brief summary
Cervical epidural steroid injections * The hanging drop (HD) technique is commonly used for identifying the cervical epidural space. * The hanging drop (HD) technique is using the negative pressure in the epidural space. * The subject of debate whether the epidural space exhibits negative pressure. * In a previous study, EP might be influenced by body position * No report or peer-reviewed literature to demonstrate the cervical epidural pressure (CEP) now. The hypothesis of this study * There is a difference in the cervical epidural pressure between in the prone and sitting positions * To evaluate this hypothesis, CEPs in the prone and sitting groups were measured and compared in the two groups. * Using a closed pressure measurement system * Under fluoroscopic guidance.
Detailed description
Cervical epidural steroid injections (CESIs) * For the conservative management of head, neck, and upper extremity pain * Important to identify the epidural space for minimizing the chance of a dural puncture injection * Dural puncture injection makes CESIs prone to rare but catastrophic complication like permanent spinal cord injury The hanging drop (HD) technique * Commonly used for identifying the cervical epidural space * Using the negative pressure in the epidural space * The subject of debate whether the epidural space exhibits negative pressure In previous studies using a closed pressure measurement systems * The epidural pressure (EP) was commonly positive at the thoracic level in the lateral decubitus position. * EP was consistently negative only in the sitting position. * EP might be influenced by body position. * The patient should be sitting for using the HD technique. No report or peer-reviewed literature to demonstrate the cervical epidural pressure (CEP) now. The hypothesis of this study * There is a difference in the cervical epidural pressure between in the prone and sitting positions * To evaluate this hypothesis, CEPs in the prone and sitting groups were measured and compared in the two groups. * Using a closed pressure measurement system * Under fluoroscopic guidance.
Interventions
PROCEDUREcervical epidural steroid injection
* After aseptic preparation and skin infiltration with 1% lidocaine * 20-gauge Tuohy needle (Tae-Chang Industrial Co., Kongju, Korea) was inserted in the midline at the C6 - C7 level * identification of the epidural space confirmed by injection of contrast medium under fluoroscope * injection of 5 mL of solution containing 10 mg of triamcinolone acetonide suspension and 1.5 mL of 0.75% levobupivacaine hydrochloride, and 3.5 mL of physiologic saline (0.9% NaCl). * Post-procedure, patients were observed for any adverse effects and followed with a neurological examination
PROCEDUREepidural pressure measurement
* The stylet within the Tuohy needle is removed when the needle was placed in C6-7 ligamentum flavum under fluoroscopic true lateral view. * Identification of the epidural space and measurement of EP was performed with a closed measurement system.
Sponsors
Seoul National University Bundang Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* cervical radicular pain caused by herniated nucleus pulpous and spinal stenosis * other conditions including herpes zoster-associated pain and sprain.
Exclusion criteria
* contraindications for CESIs, such as coagulopathy, patient refusal or infection at the proposed insertion site * previous cervical spinal surgery * pregnancy.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| cervical epidural pressure | on interventional procedure (cervical epidural steroid injetion) |
Secondary
| Measure | Time frame |
|---|---|
| the angle of the neck flexion | on interventional procedure (cervical epidural steroid injection) |
Countries
South Korea
Outcome results
None listed