Epidurography and therapeutic epidural injections: technical considerations and experience with 5334 cases.
نویسندگان
چکیده
BACKGROUND AND PURPOSE Even in experienced hands, blind epidural steroid injections result in inaccurate needle placement in up to 30% of cases. The use of fluoroscopy and radiologic contrast material provides confirmation of accurate needle placement within the epidural space. We describe our technique and experience with contrast epidurography and therapeutic epidural steroid injections, and review the frequency of systemic and neurologic complications. METHODS Epidural steroid injections were performed in 5489 consecutive outpatients over a period of 5 1/2 years by three procedural neuroradiologists. In 155 cases (2.8%), the injections were done without contrast material owing to either confirmed or suspected allergy. The remaining 5334 injections were performed after epidurography through the same needle. Patients and referring clinicians were instructed to contact us first regarding complications or any problem potentially related to the injection. In addition, the referring clinicians' offices were instructed to contact us regarding any conceivable procedure-related complications. RESULTS Only 10 patients in the entire series required either oral (n = 5) or intravenous (n = 5) sedation. Four complications (0.07%) required either transport to an emergency room (n = 2) or hospitalization (n = 2). None of the complications required surgical intervention, and all were self-limited with regard to symptoms and imaging manifestations. Fluoroscopic needle placement and epidurography provided visual confirmation of accurate needle placement, distribution of the injectate, and depiction of epidural space disease. CONCLUSION Epidurography in conjunction with epidural steroid injections provides for safe and accurate therapeutic injection and is associated with an exceedingly low frequency of untoward sequelae. It can be performed safely on an outpatient basis and does not require sedation or special monitoring.
منابع مشابه
Back to the future: epidurography.
In this issue of the AJNR, Johnson (no relation) et al (page 697) describe their experience with the use of fluoroscopy and epidurography in the placement of epidural steroids. The authors assert that the subarachnoid injection of corticosteroids is a serious complication that can be avoided with the use of epidurography. A series of 5334 outpatient epidural steroid injections were performed af...
متن کاملEpidurography contrast patterns with fluoroscopic guided lumbar transforaminal epidural injections:a prospective evaluation.
BACKGROUND Lumbar 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 epidurogra...
متن کاملThe role of fluoroscopy in cervical epidural steroid injections: an analysis of contrast dispersal patterns.
STUDY DESIGN A multicenter, retrospective analysis of cervical epidurograms. OBJECTIVES To determine the effectiveness of the loss of resistance (LOR) technique in identifying the cervical epidural space. To delineate the pattern of epidural contrast spread during cervical epidural steroid injections. BACKGROUND Previous studies have shown that if performed without fluoroscopy, the LOR tech...
متن کاملCaudal epidural steroid injections.
The caudal approach to the epidural space was first reported in 1901. Injection of steroids to treat low back pain was introduced in 1952. Caudal epidural steroid injection is a safe, effective technique when performed with appropriate care under fluoroscopic visualization. Caudal epidural injections are associated with inaccurate needle placement when performed blindly in a substantial number ...
متن کاملEffective radiation dose reduction in computed tomography-guided spinal injections: a prospective, comparative study with technical considerations
Despite the good general patient acceptance, high patient comfort, safety and precision in the needle placement, exposure to radiation in computed tomography (CT)-guided spinal interventions remains a serious concern, and is often used to argue against its use. The aim of this study was to determine the technical possibilities of reducing the radiation dose in CT-guided epidural and periradicul...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- AJNR. American journal of neuroradiology
دوره 20 4 شماره
صفحات -
تاریخ انتشار 1999