C7-1 vs C6-7 CESI

[epidural man]

18g in the neck is barbaric!

I’d use a 14g if we had ‘em.

18g for me.

Bigger = better…haven’t you heard?

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[soccrwz]

Identify C7-T1 Interlaminar space, go on side where there's more pain, anesthesize with 1% lido, go with 20g Touhy, advance a little. Enter CLO 45 degree view, keep advancing, once you get in between the spinous process going toward VILL, small squirt of contrast to verify where you're at, advance slowly with LOR/contrast, just past VILL you should be there, verify again with Contrast, then inject after two saved views. I do a bunch of CESIs every week, it used to be a lot scarier, but now I'm very comfortable with it. I say that with a caveat, it's never a comfortable experience to do one, no one should feel 'too cocky' with, but there's definitely a level of confidence that comes with it when you do it frequently.

3 shots seems way too little to me, but to each his/her own. Everyone has their way and comfort level.

Did you not mean 55 degrees in the neck?

 

[DrSpine]

Did you not mean 55 degrees in the neck?

No, 45. Really depends on how the view is. Can be anywhere from 40-50. 95% of the time its 45 degrees.

 

[lobelsteve]

No, 45. Really depends on how the view is. Can be anywhere from 40-50. 95% of the time its 45 degrees.

Except the literature saying 55.

 

[nvrsumr]

The shallower angle is safer to start. Can always go to 55 later

 

[soccrwz]

No, 45. Really depends on how the view is. Can be anywhere from 40-50. 95% of the time its 45 degrees.

Comparison of contralateral oblique view with the lateral view for fluoroscopic-guided cervical epidural steroid injection: a few salient points and optimal obliquity | Regional Anesthesia & Pain Medicine

Look at Gills review of the angles there

 

[MitchLevi]

45-48 is ideal.

 

[bedrock]

I start and rarely change from 50 degrees

 

[Taus]

I start and rarely change from 50 degrees

Same. I have used 50 from true AP on thousands of these. Do not think I have ever seen lor with the tip behind vill. Usually at or max bevel width beyond.

 

[lobelsteve]

https://www.painphysicianjournal.com/current/pdf?article=NDAxNw%3D%3D&journal=101

 

[soccrwz]

My understanding in Gill's review is more obliquity the more median you go 45 is too little 50-55 is more ideal for CESIs if spinous process is midline