CT fluoroscopy-guided cervical interlaminar steroid injections: safety, technique, and radiation dose parameters.
OBJECTIVE
Cervical epidural steroid injections are approached with trepidation because of concerns over safety, including direct spinal cord injury. CT fluoroscopy is an alternative to conventional fluoroscopy that could potentially help reduce the risk of injury by providing improved localization of the needle tip. We sought to determine rates of technical success and risk of complications in our initial cohort of patients treated with cervical interlaminar ESI performed under CTF guidance.


METHODS
In this retrospective case series, we reviewed procedural details and CTF images of 53 consecutive cervical interlaminar ESIs performed on 50 patients over a period of 8 months. Rates of technical success, incidence of complications, procedure times, and factors that influence radiation exposure were examined.


RESULTS
No symptomatic procedural complications were observed. A single case of intrathecal contrast injection was observed, from which the patient was asymptomatic. The remaining injections were all technically successful. Injections were performed at every cervical level, as high as C1-C2. Total procedure times averaged less than 20 minutes. Average CT fluoroscopic time was 24 seconds and median tube current was 70 mA.


CONCLUSIONS
CTF-guided cervical interlaminar ESI can be performed at all levels in the cervical spine with a low rate of procedural complications. Short total procedure times, CT-fluoroscopy times, and reduced tube current make this procedure a practical alternative to cervical ESI performed under conventional fluoroscopy.
Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA. peter.kranz@duke.edu
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Kranz
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Raduazo
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Gray
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Kilani
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Hoang
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009192:Myelography / Q000379:methods; D061214:Patient Safety; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage* / Q000009:adverse effects; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
D013256:Steroids