Impact of Cervical Spine Positioning on Dry Needling Safety: Cadaveric Evidence of Reduced Spinal Canal Perforation

Dry needling is a common treatment for patients with cervical pain. Dry needling techniques in this region may carry certain risks, such as spinal canal perforation. This study aimed to determine if cervical spine position impacts the frequency of perforating the spinal canal during dry needling of the deep cervical layers. In a cadaver specimen, a 0.30 × 60 mm needle was inserted approximately 1 cm lateral to the C5 spinous process using a posterior-to-anterior approach with an inferomedial trajectory. Needle techniques were performed in cervical spine positions: neutral (0°) and slight extension (10°). Ultrasound imaging was used to confirm needle placement, and measurements were taken to determine the exact location of the needle, the angulation, and the depth. Each position was tested ten times, a total of 20 insertions. Two of the ten attempts in the neutral spine position and zero of the ten attempts in slight extension resulted in spinal canal perforation. It appears that there may be a protective benefit from a slightly extended cervical position. The results of this study demonstrate the need for vigilance and awareness of cervical spine positioning when dry needling the deep cervical layers.