• Lawrence Weil, Neal H Frauwirth, Kasra Amirdelfan, Douglas Grant, and Jacob A Rosenberg.
• Department of Pain Management, John Muir Hospital Concord Campus, Concord, CA, USA.
• Arch Phys Med Rehabil. 2008 Mar 1;89(3):413-6.

ObjectiveTo describe and answer questions concerning the spread of contrast in patients receiving correctly placed lumbar epidural steroid injections (ESIs) under fluoroscopy.DesignProspective observational study.SettingAn outpatient surgery center.ParticipantsConsecutive patients (N=114) receiving ESIs under fluoroscopy who met inclusion criteria.InterventionsNot applicable.Main Outcome MeasuresSpread of contrast in relation to variables, including unilateral versus bilateral, anterior versus posterior, and spread more than 1 level caudally versus less than 1 level. Variables were examined in relation to needle tip placement, level of injection, and male versus female patients. All data were collected with fluoroscopy images in lateral and anteroposterior views after injection of 5 mL of fluid.ResultsSpread was greater than 1 segment caudally more than 75% of the time under all variables. Anterior versus posterior epidural spread on the lateral view was approximately even over all cases and anterior spread was found more often when the needle was within the width of the distal spinous process tip. Needle placement medial or lateral to the spinous process width also significantly affected whether the spread was unilateral versus bilateral. If the needle tip was lateral to the width of the spinous process, spread was unilateral 75% of the time, versus 45% of the time if the needle tip was medial.ConclusionsContrast spread is affected by needle placement, with other variables kept equal, in the performance of an interlaminar lumbar ESI. These data support the performance of interlaminar lumbar ESIs with fluoroscopic guidance and provide some parameters with which to guide the injectionist.

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