Background & Aims
The spread pattern of the ultrasound-guided retrolaminar block in the high cervical region has not yet been investigated. The aim of this cadaveric study is to evaluate the injectate spread of ultrasound-guided retrolaminar block at the level of C2, especially focusing on the anatomical elements of headache in the cervical spine.
Methods
Four fresh adult human cadavers without a history of surgical procedures in the cervical spine were studied, and both sides of the cadavers’ necks were used for the injections (n=8). With real-time ultrasound-guided visualization, the C2 retrolaminar block was performed with 2 mL of 0.1% methylene blue. Anatomical dissection was done to evaluate the staining of the nerves, joint capsules, and muscles. The dye spread within the epidural space was investigated as well.
Results
The DRG of the C2 spinal nerve, the ventral ramus of C2, the dorsal ramus of C2, and the greater occipital nerve were deeply stained in all the injections. The third occipital nerve was also deeply stained in 75% of the injections. In epidural space, the C1-2 level and the level of the C2 lamina were deeply stained in all injections.
Conclusions
This study demonstrated that a single retrolaminar block at the level of the C2 lamina was able to affect various nerves and anatomical structures which has clinical importance in the management of headache. Further clinical research to evaluate the efficacy of C2 retrolaminar block for patients with headache is needed.
References
[1] Hochberg U, Perez MF, Brill S, Khashan M, de Santiago J. A New Solution to an Old Problem: Ultrasound-guided Cervical Retrolaminar Injection for Acute Cervical Radicular Pain: Prospective Clinical Pilot Study and Cadaveric Study. Spine (Phila Pa 1976). 2021 Oct 15;46(20):1370-1377.
[2] Elsharkawy H, Ince I, Hamadnalla H, Drake RL, Tsui BCH. Cervical erector spinae plane block: a cadaver study. Reg Anesth Pain Med. 2020 Jul;45(7):552-556.
[3] Greher M, Moriggl B, Curatolo M, Kirchmair L, Eichenberger U. Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: a comparison of two selective techniques confirmed by anatomical dissection. Br J Anaesth. 2010 May;104(5):637-42.
Presenting Author
So Young Lee
Poster Authors
Topics
- Treatment/Management: Interventional Therapies – Injections/Blocks