Method to Reduce the False-Positive Rate of Loss of Resistance in the Cervical Epidural Region

Young Uk Kim, Doohwan Kim, Jun Young Park, Jae-Hyung Choi, Ji Hyun Kim, Heon-Yong Bae, Eun-Young Joo, Jeong Hun Suh, Young Uk Kim, Doohwan Kim, Jun Young Park, Jae-Hyung Choi, Ji Hyun Kim, Heon-Yong Bae, Eun-Young Joo, Jeong Hun Suh

Abstract

Background. The cervical epidural space can be detected by the loss of resistance (LOR) technique which is commonly performed using air. However, this technique using air has been associated with a high false-positive LOR rate during cervical interlaminar epidural steroid injections (CIESIs). Objective. We investigated whether the detection of LOR with contrast medium might reduce the false-positive LOR rate on the first attempt. Methods. We obtained data retrospectively. A total of 79 patients were divided into two groups according to the LOR technique. Groups 1 and 2 patients underwent CIESI with the LOR technique using air or contrast medium. During the procedure, the injection technique (median or paramedian approach), final depth, LOR technique (air or contrast), total number of LOR attempts, and any side effects were recorded. Results. The mean values for the total number of LOR attempts were 1.38 ± 0.65 (Group 1) and 1.07 ± 0.25 (Group 2). The false-positive rate on the first attempt was 29.4% and 6.6% in Groups 1 and 2, respectively (P = 0.012). Conclusions. The use of contrast medium for LOR technique is associated with a lower rate of false-positivity compared with the use of air.

Figures

Figure 1
Figure 1
AP and the contralateral oblique views under fluoroscopy. AP view (a) and the contralateral oblique view at 50 degrees ((b) and (c)) under fluoroscopy; the contralateral laminae are seen in complete cross-section view ((b) and (c)). The needle can be seen transversing between the inferior and superior laminae with the needle tip directed toward the spinolaminar line (b). And epidural space was confirmed with contrast medium injection (c).

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