{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T03:32:44Z","timestamp":1771471964963,"version":"3.50.1"},"reference-count":23,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2025,11]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n To assess the relationship between needle tip position and contrast spread pattern as well as the presence of vascular spread during cervical transforaminal epidural steroid injection (CTFESI). Additionally, to assess how different needle tip positions influence pain reduction effects.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A total of 185 consecutive patients who received\n CTFESIs<\/jats:styled-content>\n to treat neck and upper extremity pain due to cervical disc herniation or stenosis were included in the study. Data were collected from 287\n CTFESIs<\/jats:styled-content>\n , including demographic data, numeric rating scale (\n NRS<\/jats:styled-content>\n ), and fluoroscopic findings at injection. Needle tip position was categorized into the lateral, middle, and medial third areas of the articular pillar. The contrast spread pattern was classified into epidural, intraforaminal, and extraforaminal. Vascular contrast spread was divided into present and absent. The relationship between needle tip position and contrast spread pattern, as well as the presence of vascular spread, was assessed. The subsequent reductive change in\n NRS<\/jats:styled-content>\n according to needle tip position, contrast spread pattern, and vascular spread was also investigated.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Positioning the Needle in the Medial Third of the Articular Pillar Markedly Produced the Proper Epidural Spread of the Contrast as Well as the Absence of the Vascular Spread Compared to the Lateral Third Position. Moreover, a Significant Improvement in Pain Reduction and the Subsequent Epidural Contrast Flow Was Observed and Reproduced Following Needle Placement in the Medial Third Area Compared to the Other Locations.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Positioning the needle at the medial one\u2010third of the articular pillar during CTFESI promoted improved access to the optimal target area with more spread into the epidural space, as well as providing improved pain reduction.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/papr.70081","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T08:47:47Z","timestamp":1758185267000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Optimization of the Needle Tip Position for the Proper Contrast Spread Pattern and Clinical Outcomes During Cervical Transforaminal Epidural Injections"],"prefix":"10.1111","volume":"25","author":[{"given":"Jung Hwan","family":"Lee","sequence":"first","affiliation":[{"name":"Namdarun Rehabilitation Clinic Yongin Gyeonggi\u2010Do South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun Ho","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Kyung Hee University Medical Center Seoul South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sang Gyu","family":"Kwak","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, College of Medicine Catholic University of Daegu Daegu South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7629-7213","authenticated-orcid":false,"family":"Min Cheol Chang","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation College of Medicine, Yeungnam University Daegu South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aev342"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(00)90104-7"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.218.3.r01mr17886"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-006-0142-8"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmrj.12597"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0033-1354248"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-005-0542-2"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.36076\/ppj.2003\/6\/457"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181b043d1"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A3266"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnaa162"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.inpm.2021.100001"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.36076\/ppj.2012\/15\/13"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnaa050"},{"key":"e_1_2_11_16_1","first-page":"267","article-title":"The Articular Pillar View in the Assessment of Cervical Spine Trauma","volume":"13","author":"Miller J. 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