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Extraforaminal needle tip position reduces risk of intravascular injection in CT-fluoroscopic lumbar transforaminal epidural steroid injections
- Source :
- Journal of spine surgery (Hong Kong). 2(4)
- Publication Year :
- 2017
-
Abstract
- Lumbar transforaminal epidural steroid injection is a common and effective tool for managing lumbar radicular pain, although accidental intravascular injection can rarely result in paralysis. The purpose of this study is to determine the safest needle tip position for computed tomography (CT)-guided lumbar transforaminal epidural steroid injections as determined by incidence of intravascular injection.Three radiologists, in consensus, reviewed procedural imaging for consecutive CT-fluoroscopic lumbar transforaminal epidural steroid injections performed during a 16-month period. Intravascular injections were identified and categorized by needle tip position, vessel type injected, intravascular injection volume and procedural phase containing the intravascular injection. Pearson chi-square and logistic regression testing were used to assess differences between groups, as appropriate.Intravascular injections occurred in 9% (52/606) of injections. The intravascular injection rate was significantly lower (P0.001) for extraforaminal needle position (0%, 0/109) compared to junctional (8%, 27/319) and foraminal (14%, 25/178) needle tip positions. Of the intravascular injections, 4% (2/52) were likely arterial, 35% (18/52) were likely venous, and 62% (32/52) were indeterminate for vessel type injected. 46% (24/52) of intravascular injections were large volume, 33% (17/52) were small volume, and 21% (11/52) were trace volume. 56% (29/52) of intravascular injections occurred with the contrast trial dose, 29% (15/52) with the steroid/analgesic cocktail, and 15% (8/52) with both.An extraforaminal needle position for CT-fluoroscopic lumbar transforaminal epidural steroid injections decreases the risk of intravascular injection and therefore may be safer than other needle tip positions.
- Subjects :
- 0301 basic medicine
medicine.medical_specialty
Epidural steroid
medicine.diagnostic_test
business.industry
Epidural steroid injection
medicine.medical_treatment
Computed tomography
medicine.disease
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Lumbar
Radicular pain
Paralysis
medicine
Orthopedics and Sports Medicine
Surgery
Original Study
030101 anatomy & morphology
Radiology
medicine.symptom
business
Tip position
Intravascular injection
Subjects
Details
- ISSN :
- 2414469X
- Volume :
- 2
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Journal of spine surgery (Hong Kong)
- Accession number :
- edsair.doi.dedup.....4a2cfbd26618d3c41807c49614bbd912