Comparison of contrast flow and clinical effectiveness between a modified paramedian interlaminar approach and transforaminal approach in cervical epidural steroid injection

Choi, Eun Young; Nahm, Francis Sahngun; Lee, P.-B.

doi:10.1093/bja/aev342

Cited by 27 publications

(29 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More extensive cranial spread of contrast, is consistent with the findings of major epidurographic studies (17–21). Not surprisingly, the dye distribution levels (cranial and caudal) seems to depend on the volume of injected dye.…”

Section: Discussionsupporting

confidence: 88%

See 1 more Smart Citation

Ultrasound-Assisted Lumbar Interlaminar Epidural Dye Injection and Evaluation of Its Distribution by Anatomical Dissection

et al. 2019

View full text Add to dashboard Cite

Background: Epidural steroid injections are frequently used to treat lumbar radicular pain. However, the spread of a solute in the epidural space needs further elucidation. We aimed at assessing the distribution of green dye in the epidural space after lumbar epidural injection on cadavers.Methods: We performed ultrasound-guided injections of green dye between lumbar vertebrae 4 and 5 in 24 cadavers. The cadavers were randomly divided into group A and B according to the volume of injected dye; 3 ml in group A (n = 13) and 6 ml in group B (n = 11). Accuracy of the needle insertion and patterns and distributions of the spread were compared between the groups. After local dissection, we examined the spread of dye in dorsal and ventral epidural spaces and presented the distribution as whole numbers and quartiles of intervertebral segments. Mann-Whitney U Test was used to compare distribution of dye spread between groups A and B. Wilcoxon Signed-Rank Test was used to compare the spread of dye in cranial and caudal direction within the group. We considered P < 0.05 as significant.Results: Data were obtained from all 24 cadavers. Median levels of dorsal cranial dye distribution in groups A and B were 2 and 4 (P = 0.02), respectively. In the dorsal caudal−2 and 2, respectively (P = 0.04). In the ventral epidural space cranial dye spread medians were−0 and 2 in groups, respectively (P = 0.04). Ventral caudal spread was 0 and 1, respectively (P = 0.03). We found a significant difference between cranial and caudal dye distribution in group B (P < 0.05). In group A the dye spread was bilateral. In group B cranial and caudal dye spread was observed.Conclusions: Ventral dye flow was observed in 50% of injections. Bilateral spread of dye occurred in 63%, and more often in group A. Cranial spread was slightly higher than caudal spread in group A despite a smaller injected volume, and significantly higher in group B following a larger volume.

show abstract

Section: Discussionsupporting

confidence: 88%

“…It has been shown that an interlaminar approach is safer for successful epidural steroid injections (17, 24–26). Cryomicrotome epidural space studies have revealed that there are no active boundaries for distribution of solutions in epidural space (27, 28).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Assisted Lumbar Interlaminar Epidural Dye Injection and Evaluation of Its Distribution by Anatomical Dissection

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Prior investigation has shown response rates defined by either 50% or greater NRS pain score reduction or PGIC rating consistent with "improvement" in symptoms of 68% to 80% depending on the duration of followup, [21][22][23][24][25][26] consistent with the observed rates in this study (Fig. 2).…”

Section: Discussionsupporting

confidence: 87%

A Prospective Randomized Comparative Trial of Targeted Steroid Injection Via Epidural Catheter Versus Standard C7-T1 Interlaminar Approach for the Treatment of Unilateral Cervical Radicular Pain

McCormick

Nelson

Bhave

et al. 2017

Regional Anesthesia and Pain Medicine

View full text Add to dashboard Cite

This trial showed no significant difference in clinical outcomes with CIESI using a targeted epidural catheter compared to a standard C7-T1 approach for the treatment of unilateral cervical radicular pain at the C5 or C6 level. Both techniques were associated with clinically meaningful improvement across outcome domains of pain, function, disability, and medication use. These effects persisted to 6-month follow-up.The study was registered at Clinical Trials.gov (NCT02095197).

show abstract

“…However, in the cervical spine, an inter-laminar midline or paramidline injection is the option of choice, irrespective of disease categories or laterality of symptoms, because (a) an interlaminar approach is safer and more comfortable for patients, and (b) a cervical transforaminal injection has potential risk for serious complications, including cerebellar and spinal cord infarction (32,33). Choi et al (33) demonstrated that inadvertent vascular uptake and patient discomfort during procedures were significantly lower in the group in which the interlaminar approach was used than in the transforaminal approach group, and there was no statistically significant difference in symptom improvement between the two groups. A previous study by Lee et al (32) showed that a cervical paramidline injection is extremely effective in patients with cervical radiculopathy.…”

Section: Indications Choice Of Approach and Contraindicationsmentioning

confidence: 99%

Fluoroscopically Guided Epidural Injections of the Cervical and Lumbar Spine

Shim

Lee

et al. 2017

RadioGraphics

View full text Add to dashboard Cite

Advances in imaging and the development of injection techniques have enabled spinal intervention to become an important tool in managing chronic spinal pain. Epidural steroid injection (ESI) is one of the most widely used spinal interventions; it directly delivers drugs into the epidural space to relieve pain originating from degenerative spine disorders-central canal stenoses and neural foraminal stenoses-or disk herniations. Knowledge of the normal anatomy of the epidural space is essential to perform an effective and safe ESI and to recognize possible complications. Although computed tomographic (CT) or combined CT-fluoroscopic guidance has been increasingly used in ESI, conventional fluoroscopic guidance is generally performed. In ESI, drugs are delivered into the epidural space by interlaminar or transforaminal routes in the cervical spine or by interlaminar, transforaminal, or caudal routes in the lumbar spine. Epidurography is usually performed before drug delivery to verify the proper position of the needle in the epidural space. A small amount of contrast agent is injected with fluoroscopic guidance. Familiarity with the findings on a typical "true" epidurogram (demonstrating correct needle placement in the epidural space) permits proper performance of ESI. Findings on "false" epidurograms (demonstrating incorrect needle placement) include muscular staining and evidence of intravascular injection, inadvertent facet joint injection, dural puncture, subdural injection, and intraneural or intradiscal injection. RSNA, 2016 An earlier incorrect version of this article appeared online. This article was corrected on December 22, 2016.

show abstract

Comparison of contrast flow and clinical effectiveness between a modified paramedian interlaminar approach and transforaminal approach in cervical epidural steroid injection

Abstract: Institutional Review Board of Seoul National University Bundang Hospital (B-1206/159-004) and Clinical Research Information Service (KCT0000626).

Cited by 27 publications

References 24 publications

Ultrasound-Assisted Lumbar Interlaminar Epidural Dye Injection and Evaluation of Its Distribution by Anatomical Dissection

Ultrasound-Assisted Lumbar Interlaminar Epidural Dye Injection and Evaluation of Its Distribution by Anatomical Dissection

A Prospective Randomized Comparative Trial of Targeted Steroid Injection Via Epidural Catheter Versus Standard C7-T1 Interlaminar Approach for the Treatment of Unilateral Cervical Radicular Pain

Fluoroscopically Guided Epidural Injections of the Cervical and Lumbar Spine

Contact Info

Product

Resources

About