Extraforaminal needle tip position reduces risk of intravascular injection in CT-fluoroscopic lumbar transforaminal epidural steroid injections

Yu, Robinson K.; Lagemann, Gerritt M.; Ghodadra, Anish; Agarwal, Vikas

doi:10.21037/jss.2016.09.04

Cited by 7 publications

(10 citation statements)

References 38 publications

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“…Intravascular distribution of the medication applied is evident in 8-9 % of cases. The risk of this intravascular misinjection was shown in this study to be significantly lower if the needle position was slightly extraforaminally positioned [24]. This shows that a safe and yet effective needle position for the patient should be sought, especially since an absolute needle position is not correlated with success.…”

Section: Discussionmentioning

confidence: 60%

CT-guided Interventional Therapy of Back Pain – Predictors of Success in Treatment

Stueckle

Talarczyk

Hackert

et al. 2020

Rofo

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Purpose The aim of the presented study was to investigate if distribution of the drug-contrast medium mixture in CT-guided periradicular therapy can predict intervention success. Materials and Methods Over a 15-month period, 97 patients admitted to our institution by a pain physician for CT guided periradicular therapy were treated. In 420 CT guided interventions, we measured the relative distribution of the drug mixture in relationship to the neuroforamen. The distribution was correlated to the patient’s pain score over time. In addition, dependence of success in treatment with regards to the treating physician was evaluated. Results Ninety percent of the patients experienced a decrease of pain score under therapy, only 10 % showed no change. On average there was an improvement in pain score from 7.4 (2–10) before therapy to 3.7 (0–9) at the end of therapy. We observed a weak correlation of –0.22 (p < 0.028) between distribution of drug mixture to the neuroforamen and reduction of pain score. The therapy outcome displayed a dependency regarding the treating physician (p < 0.0084). Conclusion CT guided periradicular therapy offers good pain reduction in most of the patients. Drug distribution near the affected nerve and treating physician are factors for clinical success. Key Points: Citation Format

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Section: Discussionmentioning

confidence: 60%

CT-guided Interventional Therapy of Back Pain – Predictors of Success in Treatment

Stueckle

Talarczyk

Hackert

et al. 2020

Rofo

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“…There is controversy in the literature regarding the ideal needle-tip position. As shown by Yu et al (15), intravascular injection occurred more often when the needle tip was positioned foraminally. Regarding treatment effectiveness, a study by Desai et al (30) demonstrated a significantly better pain reduction with the extension of drugs in the ventral epidural space, achieved more frequently by positioning the needle tip in the superior-anterior rather than the superiorposterior aspect of the neural foramen.…”

Section: Discussionmentioning

confidence: 86%

“…According to a scheme used in previous studies, the needle-tip position was categorized as extraforaminal, junctional, or foraminal ( Fig. 4) in relation to the targeted neural foramen (15). Distances between the needle tip and the nerve root were measured (Fig.…”

Section: Imaging Analysismentioning

confidence: 99%

The retroneural approach: an alternative technique for lumbar transforaminal epidural steroid injections

Ignjatovic

Omidi

et al. 2018

Acta Radiol

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“…Notably, these epidural injection techniques are not entirely analogous to TFLPs. Percutaneous foraminal epidural injections through Kambin's triangle use a paraspinal posterolateral oblique needle trajectory through the IVF toward the intervertebral disc (Yu et al, ), whereas a TFLP needle should have a course perpendicular (or slightly less) to an IVF seen en face (Nascene et al, ). Despite these different needle trajectories toward the IVF, we propose that as the needle tip reaches the IVF, the middle segment of the posterior IVF crescent should be considered as the safe zone (since it is most devoid of neurovascular structures) and precisely targeted during either type of procedure.…”

Section: Discussionmentioning

confidence: 99%

“…For standardization purposes, we defined this as the parasagittal slice showing the smallest IVF cross-sectional area (Figure 1), as the IVF transitioned over a very short distance from within the central spinal canal to the junctional/extraforaminal space beyond the foramen. This is equivalent to a shallow "foraminal" zone (rather than the "junctional" or "extraforaminal" zones) between the facet and the intervertebral disc or vertebral body, previously demonstrated and defined on axial images by Yu et al, (2016).…”

Section: Methodsmentioning

confidence: 97%

Magnetic resonance imaging anatomy and morphometry of lumbar intervertebral foramina to guide safe transforaminal subarachnoid punctures

2019

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Percutaneous transforaminal lumbar punctures (TFLPs) offer alternative access routes to the lumbar subarachnoid cistern. Safe fluoroscopic insertion of a needle through a lumbar intervertebral foramen (IVF) should ideally avoid the exiting spinal nerve and surrounding vascular pedicles. A crescentic region in the posterior aspect of IVF is the conventional position for needle placement during TFLP, but the underlying anatomic basis for this has not been evaluated fully. To enhance TFLP safety, we defined the morphometry of normal lumbar IVFs and precise locations of neurovascular structures in the IVF posterior crescent. We retrospectively reviewed high‐resolution T2‐weighted lumbar spine magnetic resonance images of 40 normal adults to establish normative dimensions of each IVF from L1 to L5 bilaterally. We segmented the IVF posterior crescent into three parts, and within each, measured the areas occupied by neurovascular structures. We statistically correlated the presence or absence of neurovascular structures in each crescent segment using a chi‐square test. The mean morphometrics for all 304 IVFs in 10 males and 30 females of similar ages were: area 115.3 ± 29.5 mm2; height 18.0 ± 2.4 mm; and width at mid‐disc level 5.6 ± 2.1 mm. We found a significant association between crescent segment and presence or absence of neurovascular structures (χ2 = 95.9, p < .001). A post‐hoc calculation of adjusted standardized residuals identified a significant association between the middle crescent segment and absence of neurovascular structures. Thus, the middle segment of the IVF posterior crescent is significantly most devoid of neurovascular structures, and more often would be the safest target for needle placement during TFLP.

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Extraforaminal needle tip position reduces risk of intravascular injection in CT-fluoroscopic lumbar transforaminal epidural steroid injections

Cited by 7 publications

References 38 publications

CT-guided Interventional Therapy of Back Pain – Predictors of Success in Treatment

CT-guided Interventional Therapy of Back Pain – Predictors of Success in Treatment

The retroneural approach: an alternative technique for lumbar transforaminal epidural steroid injections

Magnetic resonance imaging anatomy and morphometry of lumbar intervertebral foramina to guide safe transforaminal subarachnoid punctures

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