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Since the opening of the Shizuoka Rosai Hospital in April 1967, many patients with so-called whiplash injury have been treated in the department of neurosurgery. Various kinds of pathophysiology are included in the category called whiplash injury, and we can not manage this disorder by a single treatment. Many patients with no gross roentgenological abnormality in the cervical spine have been treated successfully, with full recovery or great improvement, by the injection A steroid into the cervical epidural space, which was used as one of many treatnents of this syndrome. So we report this method in this paper with reference to is indications, technique, mechanisms of action, side effects, etc., mainly by iemonstration of cases treated by this method. The technique is rather simple. The patient is placed in the sitting position, with the head hyperflexed. The tip of the needle is inserted into the epidural space isually between C4 and C5 through the median approach by using the method of oss of resistance (Fig. 1), and 20 mg. of Predonin diluted with 10 ml. of normal saline solution is injected. In most cases, the epidural space is reached 4 to 5 cm. Irom the skin surface. The patient complains of transient pain radiating to both arms and to the back during the injection, but this usually disappears within ifteen minutes. After the injection, the patient is kept in the supine position until he pain disappears. We use a specially designed needle, 20 gauge with an obtuse )evel and marks on it showing the distance from the tip (Fig. 2). Peridural Juncture is carried out without difficulty by the above technique and can be safely lone in the out-patient department. No remarkable untoward effects have been :ncountered. Not only whiplash injury, but non-traumatic cervical syndrome has also been reated by this method. The over-all results of the treatment of cervical syndrome ly this method are shown in Fig. 3. Regardless of etiology, traumatic or non-

187. Treatment of So-Called Whiplash Injury by Injection of Steroid into the Cervical Epidural Space