Background and objectives: Early epidural space identification is critical to the efficacy and safety of cervical epidural steroid injections (CESI). Currently, the accepted method for epidural space recognition is the loss of resistance technique (LORT). I hypothesized that the contrast spread technique might recognize epidural space concurrently with or sooner than LORT and that smaller needles might be employed with the fluoroscopy-only method but not with LORT. To test my hypotheses, I conducted a comparison study.

Methods: The study participants were patients from my practice with a clinical diagnosis of cervical radiculitis, divided into two groups of 20 each, who underwent CESI with either an 18 G or a 25 G Tuohy needle. All CESIs were performed utilizing the fluoroscopy-only method. Then, LOR was tested using an Epidrum device that was observed for 30 s; if the Epidrum deflated, the result was positive.

Results: LOR was positive in 12 out of 20 patients in the 18 G group and 2 out of 20 in the 25 G group. The 95% confidence interval test for proportion revealed a statistically significantly lower rate for epidural space detection by LOR in both groups: [0.385, 0.815] in the 18 G and [-0.031, 0.231] in the 25 G group. Statistical significance of the difference between groups in LOR accuracy rate (60% vs. 10%) was confirmed by a z-test for independent proportions: z = 3.31 (p < 0.001), Cohen's h = 1.13.

Conclusion: The fluoroscopy-only method might be a safer alternative to LORT as it employs a different concept, might recognize the epidural space sooner, and favors smaller needles.

Yakov Perper is a board-certified anesthesiologist and fellowship-trained pain management physician. He earned his Medical Degree with a specialization in Anesthesia at Maimonides Medical Center, Brooklyn. Since graduating from the Pain Management Fellowship at Saint Vincentas Medical Center, NY, He had a successful record of accomplishments in the medical field. Yakov Perper started his career at Croser-Chester Medical Center, PA in 2003. Then moved to New York with an appointment as an Attending Anesthesiologist/Pain Management Doctor at Mount Sinai Hospital of Queens. He was promoted in 2004 and served as a Director of Pain Management in 2004-2005. Then he moved into Private Practice. Yakov Perper is an active member of AMA and ISIS and was awarded by the American Consumer Research Association with the American Top Anesthesiologists with specialization in Pain Management Award in 2009 and 2011. His achievements in the Medical field are recognized by the American Anesthesiological Society, as well as his two patented inventions. Device for repairing a Dural Puncture and Seated Fluoroscopy Application Device. Yakov Perper attended numerous Pain Management Conferences to continue his medical education. While at the World Pain Management Congress in Germany in September 2011, he presented his new, innovative approach for the retrograde Spinal Cord Stimulator insertion which revealed a new technique of Spinal Cord Stimulator placement. I have invented a special chair for doing injections into the neck, thoracic spine, and lumbar spine in the sitting position. This has the advantage of doing procedures safer and more convenient for the patients. I am also able to perform joint injections, shoulder joint and knee joint injections using my approach, which is relatively painless and very simple. You would not find such an approach from any other pain management provider, and you would not learn it from the textbook."