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890 - Predictive value of magnetic resonance imaging and intraprocedural cervical epidural depth

Friday, February 23, 2024
5:00 PM – 6:30 PM EDT

    Presenting Author(s)

  • SF

    Sam Famenini, MD

    Resident Physician
    MetroHealth/ Case Western Reserve University
    Cleveland, Ohio, United States

    • Co-Author(s)

  • NW

    Noah Wickerham, MD

    Resident Physician
    MetroHealth Systems
    Cleveland Heights, Ohio, United States

  • HH

    Hannah E. Hill, MS

    Research Data Scientist
    Metrohealth
    Cleveland, Ohio, United States

  • KJ

    Kevin Johnson, BS

    Medical Student
    Case Western Reserve University School of Medicine
    Cleveland, Ohio, United States

  • TH

    Terence Hillery, MD

    Assistant Professor, PM&R
    MetroHealth/Case Western Reserve University
    Cleveland, Ohio, United States

  • Gustaf M. Van Acker, MD, PhD

    Assistant Professor
    MetroHealth/Case Western Reserve University
    Cleveland, Ohio, United States

    • Corresponding Author(s)

  • CHONG KIM, MD

    Professor
    MetroHealth/ Case Western Reserve University
    gibsonia, Pennsylvania, United States

Objectives: Objective of this study is to assess if either axial and/or sagittal views of cervical magnetic resonance imaging (MRI) provide better predictive value of intraprocedural cervical epidural depth.

Design: Patient’s medical record data were obtained including age, body mass index (BMI), sagittal depth (SD) on MRI, axial depth (AD) on MRI, and depth to loss of resistance. Distance from skin to epidural space on MRI was measured from skin to posterior epidural space in both sagittal and axial images. Multivariable regression analysis was performed to determine if either sagittal or axial MRI images correlated with physician needle depth (ND) while considering other covariables such as BMI.

Results: Our sample population consisted of 91 patients. Using regression analysis and adjusting for covariates of age, sex, BMI, and cervical level, we analyzed 4 regression models: 1. predicting ND using SD while adjusting for covariates, resulting in SD β=0.73 (p< 0.001) and BMI β=0.16 (p=0.011); 2. predicting ND using AD while adjusting for covariates, resulting in AD β=0.77 (p < 0.001, covariates not significant) 3. predicting ND with both AD and SD while adjusting for covariates, resulting in β=0.46 (p< 0.001) and β=0.32 (p=0.002) respectively, covariates were not statistically significant; and 4. predicting ND using MRI measurements without adjusting for covariates, resulting in axial β=0.45 (p< 0.001) and sagittal β=0.37 (p< 0.001).

Conclusions: In our study, we evaluated the correlation between cervical MRI measurements including both axial and sagittal views and actual ND during CESI while looking at confounding variables. BMI is marginally significant when only using SD to predict ND but loses predictive power when included in models with AD. The weighted average of AD and SD together provide a reasonable estimate for CESI ND (residual standard error =4.01mm):

Predicted ND = 9.7mm + (0.45 X AD in mm) + (0.37 X SD in mm)