Title Page
Contents
국문초록 8
ABSTRACT 10
I. Introduction 12
II. Objectives 14
III. Materials and Methods 15
III.1. Study population and review of clinical data 15
III.2. Injection technique 17
III.3. Depth prediction 22
III.4. Statistical analysis 27
IV. Results 28
V. Discussion 32
V.1. Analysis of result 32
V.2. Limitation of blind technique 35
V.3. Paramedian approach vs Median approach 36
V.4. Comparing with other studies 36
V.5. Study Limitations 38
V.6. Additional Research 39
VI. Conclusion 40
References 41
Appendix 45
Table 1. Demographic Data of the Patients 29
Table 2. Agreement of PMD, PPD, and MLD with Actual Distance 30
Table 3. Demographic data based on diagnosis 45
Figure 1. Patient selection flow diagram. Abbreviations: CEB, cervical epidural block. 16
Figure 2. Prone positioning equipment (Spine Positioning System II, Oakworks Medical Co., U.S.A.) 18
Figure 3. Antero-Posterior view (A) and oblique view (B) of C-arm fluoroscopic image of confirmation of needle tip. Note... 19
Figure 4-A. 20G Tuohy needle (EH20080D, UNISIS Co., Japan) and Ruler measurements (APL-SMP-001, All Pro Co., China) 20
Figure 4-B. Measurement after CEBs. Measurement has done down to 1mm scale. Skin is marked with red oil pen. Abbreviations:... 21
Figure 5. Needle insertion point is directed with tip of curved forcep at the lower left angle of T1 vertebrae. 23
Figure 6-A. AP image of cervical x-ray; MLD is measured from midline of cervical vertebra to lateral border of vertebral body.... 24
Figure 6-B. Lateral image of cervical X-ray; dashed line represents line along the lower margin of T1 vertebra. Solid line is... 25
Figure 7. A schematic drawing of the cervical epidural block. Abbreviations: PMD, predicted median depth; PPD, predicted... 26
Figure 8-A. Bland-Altman precision analysis of the measured differences between AD and PMD. Abbreviations: PMD, predicted... 31
Figure 8-B. Bland-Altman precision analysis of the measured differences between AD and PPD. Abbreviations: PPD, predicted... 31
Figure 9. PPD and PMD difference change by PMD. Each line is drawn based on a different MLD. Dotted line is drawn based on maximum MLD value. Dashed line is drawn based on positive 95% standard... 34