Comparison of Nonimage- and Fluoroscopy-Guided Interlaminar Epidural Block: A Matched Paired Analysis in the Same Individuals

Abstract

Background. Although fluoroscopic guidance is recommended highly for more accurate lumbar interlaminar epidural steroid injection (L-ESI), many physicians still use a nonimage-guided approach for L-ESIs. However, because of its associated risk of radiation and increased medical expense, the cost-effectiveness and safety of fluoroscopy-guided ESI have been called into question. The goal of this retrospective matched paired analysis in the same individuals was to assess the effectiveness and prevalence of complications of nonimage-guided L-ESI compared to those of fluoroscopy-guided L-ESI. Methods. Between 2015 and 2016, 94 patients who received both nonimage- and fluoroscopy-guided L-ESIs were analyzed retrospectively. The changes of the numeric rating scale (NRS) in pain intensity and functional outcome and the differences in the number of complications between blind and fluoroscopy-guided L-ESIs in the same individuals were evaluated by a matched paired analysis. Results. Of the 94 patients, the differences in NRS before and after the procedure were 1.29 (95% confidence interval (CI) = 0.94–1.65) for the nonimage-guided group and 1.64 (95% CI = 1.28–2.01) for the fluoroscopy-guided group (p=0.16). More subjective functional improvement was observed in fluoroscopy-guided L-ESI (57, 60.6%) than in nonimage-guided L-ESI (47, 50.0%) without statistical significance (p=0.16). Nine (9.6%) patients in the nonimage-guided group experienced complications related to the procedure overall compared to 4 (4.3%) in the fluoroscopy-guided group (p=0.27). Conclusions. In this study, both blind and image-guided L-ESI techniques included similar extents of postprocedural outcomes and complications. Physicians should consider the risks associated with the two different techniques overall and develop ways to individualize the procedure to decrease the risk of complications and improve the positive outcomes of lumbar epidural steroid injections.

Arachnoiditis following epidural blood patch—An avoidable rare complication due to blind technique: A response

“…A more recent study by Toon et al compared epidural access for interlaminar blocks in 94 patients who received epidural access both without imaging guidance and with fluoroscopy guidance. 5 This study failed to demonstrate any statistically significant differences in regard to complication rates or improved results.…”

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“…Moreover, these procedures needed short needles and multiple insertions. [16][17][18][19][20] To overcome these limitations, we introduced a blind perifacet injection technique, which provided adequate analgesia through a single injection of local anesthetic and steroid solution with no vascular or visceral puncture and other complications. To prevent post-procedural infections, the procedure was performed aseptically.…”

Inyección epidural interlaminar ecoguiada de esteroides: evaluación de rendimiento mediante el método de la suma acumulativa (CUSUM)

“…Yoon y cols. comparan los resultados analgésicos y la aparición de complicaciones entre las inyecciones interlaminares de esteroides realizadas con fluoroscopia y las realizadas a ciegas, sin encontrar diferencias entre ambas (12). La inyección intravascular utilizando el abordaje interlaminar en pacientes no obstétricas, es efectivamente extremadamente rara.…”