Fluoroscopic analysis of lumbar epidural contrast spread after retrograde interlaminar ventral epidural injection (RIVEI)

Abstract

BackgroundRetrograde interlaminar ventral epidural injection (RIVEI) may hypothetically be more effective if the catheter is placed at the ventrocaudal aspect of the exiting nerve. We tested that hypothesis by measuring ventral and dorsal epidural contrast flow during RIVEI.MethodsTo perform RIVEI, a 17 G Tuohy needle was inserted to access the epidural space. A 19 G epidural catheter was inserted and advanced through the needle, passing in a caudal direction to the lower aspect of the contralateral pedicle. Fluoroscopic images were recorded at 1.5 ml increments of contrast. Based on the images of contrast dispersal, the extent of contrast spreading was assessed in 82 patients.ResultsAll 82 patients (100%) injected with 3.0 ml contrast medium demonstrated ventral epidural spreading. Mean spreading level from the catheter tip was 2.21 ± 0.93 with 3.0 ml of contrast. Spreading to the superior aspect of the supra-adjacent intervertebral disc was observed in 67/82 (81.7%) of RIVEIs with 3.0 ml of contrast injected into the ventral epidural space. We found that 3.0 ml of contrast reached the inferior aspect of the infra-adjacent intervertebral disc in 95.1% (78/82) of RIVEIs performed.ConclusionsOur findings imply that a one-level RIVEI may be sufficient in situations where a two-level injection would currently be used.

Transforaminal Epidural Balloon Adhesiolysis via a Contralateral Interlaminar Retrograde Foraminal Approach: A Retrospective Analysis and Technical Considerations

“…Previous studies suggested that the use of a retrograde interlaminar dorsal epidural approach with ventral epidural catheterization may be an effective approach to deliver medication to the target site [14,15,20]. Although the catheter is placed in the dorsal epidural space, contrast medium is delivered evenly to both the ventral and dorsal epidural spaces [14].…”

“…Previous studies suggested that, in comparison with conventional TFESI, drugs can be delivered more effectively to the target site by retrograde interlaminar ventral epidural injection, usually at the ventral aspect of the nerve root sleeve, dorsal aspect of disc herniation, or stenotic lesion [14,20]. Moreover, in cases of dorsal epidural spread, the retrograde interlaminar approach showed greater flow than in the conventional transforaminal approach [14,20].…”

Interventional Therapies for Chronic Low Back Pain

“…The transforaminal approach (Fig. ) delivers medication around the affected nerve root with spread into the anterior epidural space . The caudal approach utilizes the opening at the sacral hiatus to deliver medication to the lower lumbar spine area .…”

Relationship between needle depth for lumbar transforaminal epidural injection and patients' height and weight using magnetic resonance imaging

“…An interlaminar epidural injection spreads into the dorsal epidural space and diffuses to the ventral target site [ 6 , 10 ]. Consequently, the concentration of the injecting agent is inadequate [ 11 ] or an epidural catheter should be inserted and positioned in the ventral epidural space [ 12 ]. TFEI can deliver the injectate precisely to the damaged nerve root and anterior epidural space, resulting in better outcomes, such as long-term efficacy and improved effects [ 1 , 6 , 12 , 13 ].…”