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

Impact of Cervical Spine Positioning on Dry Needling Safety: Cadaveric Evidence of Reduced Spinal Canal Perforation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Impact of Cervical Spine Positioning on Dry Needling Safety: Cadaveric Evidence of Reduced Spinal Canal Perforation Tyler Miller, Christi Williams, Christian R. Falyar, Ryan C. McConnell This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7365707/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract 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. Health sciences/Anatomy Health sciences/Health care Health sciences/Medical research Dry Needling Cervical Spine Safety Adverse Events Cervical Hematoma Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementalMaterial1.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 12 Feb, 2026 Reviews received at journal 11 Feb, 2026 Reviews received at journal 11 Feb, 2026 Reviews received at journal 01 Feb, 2026 Reviews received at journal 26 Jan, 2026 Reviewers agreed at journal 14 Jan, 2026 Reviewers agreed at journal 12 Jan, 2026 Reviewers agreed at journal 12 Jan, 2026 Reviewers agreed at journal 12 Jan, 2026 Reviewers agreed at journal 12 Jan, 2026 Reviewers invited by journal 12 Jan, 2026 Editor assigned by journal 09 Sep, 2025 Editor invited by journal 22 Aug, 2025 Submission checks completed at journal 19 Aug, 2025 First submitted to journal 19 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7365707","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":573507582,"identity":"8339b0c9-9630-4952-9255-3ab3b599e99c","order_by":0,"name":"Tyler Miller","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYBAC+wPMDSCah48dSH5sYJCBSjDj1MLGwAjRwgZUwzizgYEHyAEJEdbCANLCzEuUFonExscVDNtk2JiZj3223WHDo9vee/wBQ4V1YgNuLc2GZxhuAx3Gljw790waj9mZc0DVZ9LxaWmTbABr4TFmzm07zGN2I8ewgbHtMD4t7T8hWvg/M1u2/Ydq+YdXSxsj1BZmZsa2A1AtDXi08DxslmwwAPvFmLH3TDLQL2cMZyQcSzfGqYU9+eDHhorb9vzszY8Zfu6wkzM73mPw4UONtSwuLQwCCUDCAF00AZdyEOA/gE92FIyCUTAKRgEQAAAiE1DYD/iRsgAAAABJRU5ErkJggg==","orcid":"","institution":"Belmont University","correspondingAuthor":true,"prefix":"","firstName":"Tyler","middleName":"","lastName":"Miller","suffix":""},{"id":573507583,"identity":"c53803ac-7654-4b7c-87a8-0677123df1d8","order_by":1,"name":"Christi Williams","email":"","orcid":"","institution":"Belmont University","correspondingAuthor":false,"prefix":"","firstName":"Christi","middleName":"","lastName":"Williams","suffix":""},{"id":573507584,"identity":"89c53e3c-ba3a-4bc7-9742-f6999a0b93d4","order_by":2,"name":"Christian R. 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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. 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