Kitei Paul M, Surrey David E, Simon Jeremy I, Stolzenberg David S
From the Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (PMK, JIS, DSS); and Department of Physical Medicine and Rehabilitation, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania (PMK, DES, JIS, DSS).
Am J Phys Med Rehabil. 2023 Jan 1;102(1):e3-e6. doi: 10.1097/PHM.0000000000002086. Epub 2022 Aug 9.
The epidural space is commonly accessed via an interlaminar or transforaminal approach to administer corticosteroids for radicular pain. An alternative is a transarticular approach, which may be considered when conventional access to the epidural space is either not desired or contraindicated. This approach has been described in the cervical spine using computed tomography guidance but not fluoroscopic guidance. We describe a cervical transarticular approach to the epidural space under fluoroscopy and review the computed tomography-guided literature. The risks of transarticular epidural injections are likely low given that when performed prudently, they avoid direct contact with the vertebral artery, spinal medullary arteries, venous plexus, spinal cord, and nerve roots.
硬膜外间隙通常通过椎板间或经椎间孔途径进入，以注射皮质类固醇治疗神经根性疼痛。另一种方法是经关节突途径，当不希望或禁忌采用传统的硬膜外间隙进入方法时可考虑使用。这种方法已在颈椎中使用计算机断层扫描引导进行了描述，但未使用荧光透视引导。我们描述了在荧光透视下经关节突进入颈椎硬膜外间隙的方法，并回顾了计算机断层扫描引导的相关文献。鉴于谨慎操作时经关节突硬膜外注射可避免与椎动脉、脊髓动脉、静脉丛、脊髓和神经根直接接触，其风险可能较低。
