Novel method for modified interlaminar approach using contralateral oblique view: A technical suggestion

A modified interlaminar (MIL) approach has been proposed for improved accessibility to the target epidural space. However, even with fluoroscopic guidance, uncertainty about the distance between the needle tip and the epidural space can remain. Using the contralateral oblique (CLO) view, determinati...

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Bibliographic Details
Published in:PloS one 2021-01, Vol.16 (1), p.e0244992-e0244992
Main Authors: Baek, Jungwon, Kim, Jia, Cho, Seunghee, Jeong, Yujin, Kim, Eung Don
Format: Article
Language:English
Subjects:
Accessibility
Adult
Aged
Aged, 80 and over
Analgesia - methods
Anesthesia, Epidural - methods
Anesthesiology
Biology and Life Sciences
Care and treatment
Epidural
Epidural Space - diagnostic imaging
Female
Fluoroscopy
Health risks
Humans
Lumbar Vertebrae - diagnostic imaging
Magnetic Resonance Imaging
Male
Medical records
Medical schools
Medicine
Medicine and Health Sciences
Middle Aged
Pain
Patients
People and places
Physiological aspects
Physiological research
Radiculopathy - diagnostic imaging
Radiculopathy - therapy
Research and Analysis Methods
Retrospective Studies
Safety
Spinal canal
Uncertainty
Citations: Items that this one cites
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Summary:A modified interlaminar (MIL) approach has been proposed for improved accessibility to the target epidural space. However, even with fluoroscopic guidance, uncertainty about the distance between the needle tip and the epidural space can remain. Using the contralateral oblique (CLO) view, determination of the epidural space can be easier with clearer identification of the interlaminar opening. We inserted the needle at the midpoint of the interlaminar opening on the fluoroscopic anteroposterior (AP) view and made the needle oriented toward the pedicle of the target side. Then, CLO view was created by rotating the intensifier approximately 45 degrees to the contralateral side of the target. Through the CLO view, the ventral interlaminar line (VILL) was confirmed and the needle was able to enter the epidural space more easily. The medical records of 29 patients who were conducted MIL approach using CLO view were retrospectively analyzed to evaluate the effectiveness and safety of this procedure. The accessibility to the ventral epidural space was 93.1%. There was no procedure-related complication. Using CLO view, uncertainty can be reduced during the MIL approach, which in turn shortens procedure time and improves safety.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0244992