Novel method for modified interlaminar approach using contralateral oblique view: A technical suggestion

Abstract

A modified interlaminar (MIL) approach has been proposed for improved accessibility to the target epidural space. However, even with fluoroscopic guidance, uncertainty about the distance between the needle tip and the epidural space can remain. Using the contralateral oblique (CLO) view, determination of the epidural space can be easier with clearer identification of the interlaminar opening. We inserted the needle at the midpoint of the interlaminar opening on the fluoroscopic anteroposterior (AP) view and made the needle oriented toward the pedicle of the target side. Then, CLO view was created by rotating the intensifier approximately 45 degrees to the contralateral side of the target. Through the CLO view, the ventral interlaminar line (VILL) was confirmed and the needle was able to enter the epidural space more easily. The medical records of 29 patients who were conducted MIL approach using CLO view were retrospectively analyzed to evaluate the effectiveness and safety of this procedure. The accessibility to the ventral epidural space was 93.1%. There was no procedure-related complication. Using CLO view, uncertainty can be reduced during the MIL approach, which in turn shortens procedure time and improves safety.