title: Multicenter survey of attitudes and perceptions of pain medicine fellows toward the use of lateral versus contralateral-oblique fluoroscopic view for interlaminar cervical epidural injection.
abstract: OBJECTIVE
  For interlaminar cervical epidural steroid injections (CESI) the lateral fluoroscopic view (LAT) is often considered to improve needle localization. However, the contralateral-oblique view (CLO) is a useful alternative with potential advantages to improve identification of cervical anatomy and needle depth assessment. The authors explored the attitudes and perceptions of pain medicine fellows currently training in two ACGME-accredited pain medicine fellowship programs regarding the use of these two types of fluoroscopic views.
  
  
  METHODS
  The survey was conducted online following a request by e-mail. Of a total of 20 fellows who were contacted, there were 17 respondents who had experience with both techniques, and they were included for analysis.
  
  
  RESULTS
  The response rate for participation was 95%. Whereas 70.6% respondents reported they were very certain about the assessment of anatomy with the CLO view, only 17.6% felt very certain with the LAT view. Compared with learning to perform interlaminar CESI using the LAT view only, the majority of fellows thought that using the CLO technique was easier to learn (P < 0.01) and offered better visualization of contrast dye spread pattern to confirm the cervical epidural space (P = 0.013). All respondents perceived that the likelihood of interlaminar CESI complications would be lower with CLO technique. Overall, 82.4% of respondents considered CLO visualization as a preferred technique for interlaminar CESI. Respondents stated that the likelihood of using the CLO technique as an independent physician was significantly higher than using only the LAT technique (P < 0.001), particularly for patients who are obese and have short necks.
  
  
  CONCLUSIONS
  For interlaminar CESI, using the CLO is perceived to provide better definition of anatomy and yet is easier to learn. Trainees may become more confident in performing interlaminar CESI with the CLO. We encourage all fellowship programs to include the CLO technique for interlaminar CESI as part of the training.
authors.affiliation: Division of Pain Medicine, Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Jain
authors.forename: Eric R
authors.initials: ER
authors.lastname: Helm
authors.forename: Srdjan S
authors.initials: SS
authors.lastname: Nedeljkovic
authors.forename: Ajay D
authors.initials: AD
authors.lastname: Wasan
authors.forename: Haibin
authors.initials: H
authors.lastname: Wang
mesh_terms: D002574:Cervical Vertebrae; D005257:Fellowships and Scholarships; D005471:Fluoroscopy; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007268:Injections, Epidural / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010820:Physicians; D025321:Surgery, Computer-Assisted / Q000379:methods*; D011795:Surveys and Questionnaires
keywords: Epidural; Fluoroscopy; Pain Training Programs