Journal of Pain & Relief
Open Access

Abstract

Epidural injections with multiple substances seriously started in the 1970?s. Site-specific catheter placement in the cervical epidural space was started by Racz in the early 80?s. The frequency of fluoroscopic guidance increased with the arrival of a soft-tipped, X-ray visible, unkinkable catheter that could be steered to the desired target site. The recognition of degenerative changes such as leaky discs, trauma, and surgical procedures can lead to scar formation and compression not only of the nerves exiting the spinal canal, but also venous runoff causing venous distention, edema from the venous side, cervical pain from the dural adhesions to the posterior longitudinal ligament, and radiculopathy from restriction and compression of nerve roots from scar formation. Any injection in the spinal canal with limited space can lead to loculation and compression of blood supply to the spinal cord which can lead to ischemic changes in myelopathy and in some instances cord injury as well as syrinx formation. The recognition of ischemia can be treated with flexion rotation to enlarge the neural foramina and allow runoff. Unusual contrast spreads from the injection side can be a danger sign and is becoming a standard of practice to treat it by the flexion rotation. The danger sign is the contrast spreading in the absence of runoff to the outside, to the upper inside of the spinal canal because of the dye spread follows the large ventral veins in the perivenous space. This is referred to as perivenous counterspread (PVCS). The benefits of lysis of adhesions followed by neural flossing exercises and long-term favorable outcome from cervical lysis of adhesions will be presented.

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