• Pain physician · Apr 2004

    Epidurography contrast patterns with fluoroscopic guided lumbar transforaminal epidural injections:a prospective evaluation.

    • Kenneth Botwin, James Natalicchio, and Lee Ann Brown.
    • Florida Spine Institute, 2250 Drew Street, Clearwater, FL 33765, USA. contactus@floridaspineinstitute.com
    • Pain Physician. 2004 Apr 1;7(2):211-5.

    BackgroundLumbar transforaminal epidural injections have been utilized in the treatment of radicular pain with proven success. It was postulated that interlaminar epidural injections result in a dorsal flow of contrast while transforaminal epidural steroid injections showed good ventral flow limited to one single spinal motion segment. There have been no published studies evaluating epidurography/contrast patterns utilizing fluoroscopy.ObjectiveTo evaluate the pattern and spread of epidural contrast during fluoroscopically guided lumbar transforaminal epidural steroid injections.DesignA prospective study of case series of 20 consecutive patients receiving lumbar transforaminal epidural injections.MethodsPatients had either herniated nucleus pulposus or lumbar spinal stenosis. All patients received their injection by one of five physicians trained in this technique. Once the needle tip was felt to be in the anterior epidural space anteroposterior and a lateral radiographs were obtained after a total of 2 mL of iopamidol (Isovue) contrast was injected. Epidurograms were reviewed by a physician trained in fluoroscopic injections. Patterns were recorded as unilateral, bilateral, dorsal or ventral. Ventral flow, both cephalad and caudal, and number of lumbar intervertebral levels of flow were recorded as well.ResultsVentral contrast flow occurred in all 20 injections. Unilateral contrast flow was noted in all injections. The mean number of levels of flow of contrast cephalad and caudad from the injection site were 1.13 and 0.6 levels, respectively, but these differences were not statistically significant. There were no significant differences in contrast flow noted between patients with herniated nucleus pulposus or lumbar spinal stenosis. Vascular injection patterns were noted with 2 injections, which required repositioning of the needles.ConclusionContrast appeared ventrally and unilaterally in all injections. Dorsal flow occurred in 20% of these injections. No contrast flow crossed the midline. The observed contrast flow patterns should be studied clinically to determine whether they have any effect on clinical outcome. Intravascular injections were noted in 10% of cases.

      Pubmed     Free full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…