Optimization of the Needle Tip Position for the Proper Contrast Spread Pattern and Clinical Outcomes During Cervical Transforaminal Epidural Injections

ABSTRACT Objective To assess the relationship between needle tip position and contrast spread pattern as well as the presence of vascular spread during cervical transforaminal epidural steroid injection (CTFESI). Additionally, to assess how different needle tip positions influence pain reduction effects. Methods A total of 185 consecutive patients who received CTFESIs to treat neck and upper extremity pain due to cervical disc herniation or stenosis were included in the study. Data were collected from 287 CTFESIs , including demographic data, numeric rating scale ( NRS ), and fluoroscopic findings at injection. Needle tip position was categorized into the lateral, middle, and medial third areas of the articular pillar. The contrast spread pattern was classified into epidural, intraforaminal, and extraforaminal. Vascular contrast spread was divided into present and absent. The relationship between needle tip position and contrast spread pattern, as well as the presence of vascular spread, was assessed. The subsequent reductive change in NRS according to needle tip position, contrast spread pattern, and vascular spread was also investigated. Results Positioning the Needle in the Medial Third of the Articular Pillar Markedly Produced the Proper Epidural Spread of the Contrast as Well as the Absence of the Vascular Spread Compared to the Lateral Third Position. Moreover, a Significant Improvement in Pain Reduction and the Subsequent Epidural Contrast Flow Was Observed and Reproduced Following Needle Placement in the Medial Third Area Compared to the Other Locations. Conclusion Positioning the needle at the medial one‐third of the articular pillar during CTFESI promoted improved access to the optimal target area with more spread into the epidural space, as well as providing improved pain reduction.