Prediction of the Cervical Epidural Space Depth from the Skin Using Cervical X-Ray, During Cervical Epidural Block with Paramedian Approach

Abstract

Objective

The purpose of this study is to compare the actual needle depth measured during cervical epidural block (CEB) with the predicted needle depth measured through a cervical flexion x-ray image at the paramedian approach.

Methods

The study was conducted based on the medical records of patients who underwent CEB at the pain clinic of Haeundae Paik Hospital. The actual needle distance (AD) was recorded after each successful CEB. The distance from the spinolaminar line to the skin, predicted median depth (PMD), was measured using lateral x-ray images. The medial to lateral distance (MLD), which is the distance from the midline of the spine to the needle insertion point, was measured using anteroposterior (AP) x-rays. The predicted paramedian depth (PPD) was calculated using the Pythagorean formula. The PMD represents the expected depth of the median approach, while the PPD represents the expected depth of the paramedian approach. The PMD, PPD, and AD were compared with each other.

Results

Concordance correlation coefficient (CCC) and Bland-Altman analysis were obtained for PMD and PPD. The CCC value of PMD was measured as 0.829, and the CCC value of PPD was measured as 0.830. In the Bland-Altman analysis, PPD was measured at −0.13 ± 8.37 mm, and PMD was measured at 1.29 ± 8.38 mm.

Conclusion

When performing CEB through the paramedian approach, the depth can be predicted using a cervical flexion x-ray. At this time, the PMD can also be used to predict the depth during the paramedian approach.

Keywords:

• cervical epidural block
• paramedian approach
• median approach
• prediction
• cervical flexion x-ray

Ethics and Consent

This study was conducted as a retrospective study and was exempt from obtaining individual patient consent as it was conducted without any patient identification and based on EMR data. This study has been approved by the Institutional Review Board of Inje University Haeundae Paik Hospital. This study is in compliance with the Declaration of Helsinki.

Disclosure

The authors report no conflicts of interest in this work.