A, Schematic representation of an anteroposterior view shows orientation of the blunt-tipped Whitacre needle relative to the lamina at the C7–T1 level.

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Presentation transcript:

A, Schematic representation of an anteroposterior view shows orientation of the blunt-tipped Whitacre needle relative to the lamina at the C7–T1 level. A, Schematic representation of an anteroposterior view shows orientation of the blunt-tipped Whitacre needle relative to the lamina at the C7–T1 level. The needle tip is midline in the dorsal epidural space. An introducer needle is used before placement of the blunt-tipped 22-gauge Whitacre needle. In smaller patients, the introducer needle may be left in place for coaxial insertion of the needle. In larger patients, the 18-gauge needle is removed after skin puncture and before introduction of the Whitacre needle, as the hub of this needle limits the depth of the epidural needle insertion. The needle is advanced rostral and central toward the midline interlaminar gap with the use of intermittent fluoroscopy. Contact with the lamina before entry into the epidural space provides depth control, which is crucial to prevent cord injury. B, After needle placement, 4 to 5 mL of iohexol, 240 mg/mL, is injected, followed by anteroposterior radiography, which reveals diffuse opacification of the lower cervical and upper thoracic epidural space with extension of contrast material along the proximal nerve sheaths bilaterally.C, Oblique radiograph shows needle placement over the lamina and into the spinal canal. Contrast agent in the posterior epidural space is profiled in this projection. No venous or thecal sac opacification is exhibited.D, Lateral radiograph after steroid injection and removal of the needle reveals widespread dispersal of the previously injected contrast agent within the cervical epidural space, outlining the unopacified cervical thecal sac. Blake A. Johnson et al. AJNR Am J Neuroradiol 1999;20:697-705 ©1999 by American Society of Neuroradiology