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A. The epidural space was confirmed by epidural puncture with the laminectomy needle (not withdrawn). At this point, the position of the needle can be observed under the X-ray line, and the direction of the needle entry can be adjusted according to the image. A 5~10ml syringe with 3~5ml water for injection (or normal saline) and 1ml~2ml bubbles is attached at the head of the needle. Withdraw the needle slightly, so that the tip of the needle slightly away from the bone surface, adjust the needle body slightly inclined direction, uniform advance. First, the tip should touch the bone surface of the medial edge of the lamina or facet, and then move the tip inward to the medial edge of the lamina bone surface. At this point, on the one hand, push the syringe core, only the air bubble in the syringe should be compressed, but no water in the syringe is pushed in; That is, this part has obvious resistance (positive pressure); Secondly, when the tip of the needle penetrates into the ligamentum flavum, the following negative pressure phenomena will immediately occur:

One is the sense of disappointment of puncture, that is, the thick and tough feeling and clear sense of disappointment when passing through the ligamentum flavum.

Second, water injection without resistance, bubbles still exist and not compressed.

Third, the water inserted into the spinal canal can no longer be sucked back out, proving that the space is negative pressure.

Fourth, when injecting water into the epidural space, there should be nerve root stimulation phenomenon, waist, hip until lower limbs, feeling acid swelling or tingling sensation, that is, copy the patient's original symptoms and signs, confirm the needle in the epidural space is correct, but also verify the accuracy of diagnosis.

Fifth, if the sense of failure of ligamentum flavum is not obvious, repeated negative pressure test must be done. In the end, there must be no blood and no liquid, no resistance is pushed into normal saline or a small amount of air, and no liquid or gas is sucked back out. Only then can the epidural puncture be confirmed.

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