Use of Fluoroscopy for Interlaminar Lumbar Epidural Injection: Is Confirmation with Epidurogram Necessary?

We compared the loss of resistance (LOR) technique and fluoroscopy with the LOR technique, fluoroscopy, and epidurography for interlaminar epidural injection. A total of 371 patients with symptomatic lumbosacral radiculopathy were enrolled; 17 had a history of allergy to iodinated contrast medium or seafood. Each patient was given an oral steroid before and after the procedure. A Tuohy needle was inserted into the epidural space using the LOR technique and fluoroscopy for guidance. After confirming that the needle was in the epidural space, 3 cc of nonionic contrast medium was injected and an epidurogram was performed. No patient with a history of allergy had an adverse reaction to the nonionic contrast medium. This study suggests that the routine use of an epidurogram, even in patients with a history of allergy to iodinated contrast, after preparation with oral steroids, is justified.