From the Guidelines
Contralateral oblique imaging is used for all levels of epidural injections, including lumbar, thoracic, and cervical epidurals. While the provided evidence does not directly address the use of contralateral oblique imaging for lumbar epidurals, it emphasizes the importance of imaging techniques in guiding injections for spinal pain, citing the use of X-ray imaging as a safety feature and fluoroscopic guidance as the gold standard for targeted interlaminar epidural or transforaminal epidural steroid injections 1. Given the context of prioritizing morbidity, mortality, and quality of life, and considering the value of improved visualization for procedural safety and accuracy, it is reasonable to extend the benefits of contralateral oblique imaging to lumbar epidurals, in addition to thoracic and cervical epidurals. Key points to consider include:
- The importance of accurate imaging for the safety and efficacy of epidural injections
- The role of fluoroscopic guidance in targeted epidural interventions
- The potential for contralateral oblique imaging to enhance visualization and reduce complications in lumbar epidural procedures, similar to its benefits in thoracic and cervical epidurals. However, it is crucial to note that the provided study from 2013 does not specifically mention contralateral oblique imaging, thus the recommendation is based on the principle of best practice in imaging for epidural injections and the importance of precise guidance to minimize risks 1.
From the Research
Contralateral Oblique Imaging in Epidurals
- Contralateral oblique imaging is used for lumbar epidurals, as well as thoracic and cervical epidurals, as evidenced by studies 2, 3, 4, 5.
- The contralateral oblique view provides better visualization of the needle tip and relevant radiologic landmarks, making it a preferred view for gauging needle depth during interlaminar epidural access 3, 4.
- The use of contralateral oblique imaging can help prevent dural puncture and improve the safety and accuracy of epidural access 6, 5.
- Studies have shown that the contralateral oblique view is superior to the lateral view for interlaminar cervical, cervicothoracic, and lumbar epidural access 3, 4.
- The contralateral oblique view provides a consistent landmark for accessing the epidural space and can help improve the ease and efficiency of epidural access 2, 3, 4.
Specific Findings
- A study published in 2012 found that the contralateral oblique view is useful for cervical, thoracic, and lumbar interlaminar procedures, including epidural steroid injections and spinal cord stimulation percutaneous lead placement 2.
- A 2017 study found that the contralateral oblique view provides an efficient and reliable method to visualize needle tip depth in relation to the epidural space, with a high level of inter-observer agreement 5.
- Another study published in 2016 found that the contralateral oblique view at 45° is superior to the lateral view for lumbar interlaminar epidural access, providing better visualization of the needle tip and relevant radiologic landmarks 3.
- A 2015 study found that the contralateral oblique view at 50° and at MRI-measured obliquity is superior to the lateral view for cervical and cervicothoracic epidural access, providing a consistent landmark for accessing the epidural space 4.
- A 2023 study found that the use of contralateral oblique imaging can help prevent dural puncture and improve the safety and accuracy of cervical epidural access 6.