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.

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.

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.