Proposed Technique for Ultrasound-Guided Cervical Interlaminar Epidural Pharmacopuncture

Objectives: This proposal aims to establish a standardized ultrasound-guided cervical interlaminar epidural pharmacopuncture technique using 5% dextrose as an alternative to conventional fluoroscopy-guided methods.It addresses limitations such as radiation exposure, limited soft-tissue visualization, and false loss-of-resistance responses related to the retrodural space of Okada.Methods: With the patient positioned prone and the cervical spine slightly flexed, the target level is identified using high-resolution ultrasound based on the morphology of the transverse processes, starting at C7.A posterolateral transverse scan is performed to visualize the "triple bar sign," which represents the interspinous ligament, ligamentum flavum, and dura mater.A tangential in-plane needle trajectory is used to access the posterior epidural space.To prevent a sudden increase in epidural pressure, D5W is injected using a fractionated protocol: an initial 0.5 mL test dose is administered to confirm anterior dural displacement under real-time ultrasound visualization, followed by incremental injections of 0.5 mL until a total of 3-5 mL is delivered depending on the patient's response.Discussion: Direct visualization of neural, vascular, and dural structures improves needle placement accuracy compared to tactile Loss-of-Resistance (LOR) blind techniques and may reduce the risk of unintended retrodural or intravascular injections. Conclusion:The proposed ultrasound-guided method offers a radiation-free, tissuevisualized approach for cervical epidural pharmacopuncture and may serve as a practical and safe procedural framework in clinical settings.Further clinical research is necessary to evaluate treatment outcomes and long-term safety.