Incidence of simultaneous epidural and vascular injection during lumbosacral transforaminal epidural injections

Smuck, Matthew; Fuller, Bret E.; Yoder, Brian; Huerta, J. C. Torres

doi:10.1016/j.spinee.2006.06.380

Cited by 80 publications

(70 citation statements)

References 14 publications

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“…1 Intra-arterial needle tip placement during TFESI can, in fact, not be excluded with certainty by using intermittent fluoroscopy, 26,27 aspiration, 27-30 contrast injection, 1 or even digital subtraction angiography. 1,31 In addition, none of these imaging methods would help avoid other injury mechanisms such as arterial transection or dissection.…”

Section: Misconceptions Regarding Spinal Vascular Anatomy and The "Samentioning

confidence: 99%

Intraforaminal Location of Thoracolumbar Radicular Arteries Providing an Anterior Radiculomedullary Artery Using Flat Panel Catheter Angiotomography

Gregg

Sorte

Gailloud³

2017

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Flat panel catheter angiotomography performed during the selective injection of intersegmental arteries offers a multiplanar assessment of the intraforaminal course of the radicular arteries providing an anterior radiculomedullary artery. Injury of anterior radiculomedullary arteries during transforaminal epidural steroid injections can result in spinal cord damage. Evaluations of the intraforaminal location of these arteries have so far been limited to anteroposterior views or the examination of cadaveric material. This study documents the in vivo intraforaminal location of thoracolumbar arteries providing an anterior radiculomedullary artery with flat panel catheter angiotomography.

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Section: Misconceptions Regarding Spinal Vascular Anatomy and The "Samentioning

confidence: 99%

Intraforaminal Location of Thoracolumbar Radicular Arteries Providing an Anterior Radiculomedullary Artery Using Flat Panel Catheter Angiotomography

Gregg

Sorte

Gailloud³

2017

AJNR Am J Neuroradiol

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“…This coupled with the pain at injection site lead us to admit all patients for a minimum of 12 hours. 17 This is the justification for the 24 hours' admission of the highvolume group. All patients with low volume injections were comfortable within 2 hours of injection and did not warrant admission.…”

Section: Discussionmentioning

confidence: 99%

A prospective study to evaluate the efficacies of low volume and high volume caudal epidural steroid injections in the treatment of lumbar degenerative disc disease

Sajeev

Karuppal

2017

Int J Res Med Sci

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Background: To evaluate the efficacy of low volume corticosteroid injections in the treatment of radiculopathy associated with lumbar degenerative diseases by comparing with that of conventional high-volume injection and appreciate the advantages of the technique. Study was a prospective comparative study. Setting was the operating room.Methods: 52 patients, they were randomized into two groups. Among them, 27 had undergone caudal epidural steroid injection (CESI) with low volume and 25 with high volume injections of triamcinolone. Intervention of the study was caudal epidural steroid injection (CESI) to all patients in both groups. Low volume group received 5 ml and high-volume group received 15 ml diluted triamcinolone solution. They were evaluated with the visual analog scale, Oswestry low back disability questionnaire, short form 12, relief of claudication and neurological disability.Results: There was no statistically significant difference in the clinical improvement between the two groups. However, there are definite distinct advantages of low volume injection such as lesser pain at injection site and no complications that warrant admission.Conclusions: The low volume technique of CESI is superior to the traditional high-volume technique in this study. Despite earlier concepts that low volume injections failed to penetrate the proximal epidural spaces, present study conclusively proved that it is superior to high volume injections.

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“…For the injections guided with contrast material and fluoroscopy, the rate of vascular penetration was reported to be 8.9% to 21.3%. [8] In case of dural puncture, intrathecal analgesic/ corticosteroid injection may cause to compression, cauda equina syndrome, neural toxicity or local anesthetic toxicity because of increased volume of neural elements. [9] The most common complication of dural puncture is to introduce the anesthetic substance into subdural space.…”

Section: Discussionmentioning

confidence: 99%

Comparison Of Blunt And Sharp Needles For Transforaminal Epidural Steroid Injections

Özcan¹,

Şahín²,

Gurbet³

et al. 2012

Agri

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Özet Amaç SummaryObjectives: The aim of this study was to compare the sharp and blunt needles in order to determine the incidence of complications during transforaminal anterior epidural steroid injections. Methods: In this retrospective study, 185 cases that undergo transforaminal epidural steroid injection with sharp or blunt needles were evaluated between June 2004 and December 2008. Patients age, sex, diagnosis, needle type (sharp or blunt), volume of local anesthetic and steroid injected, complications (paresthesia, dural puncture, bleeding, paralysis, intravascular penetration, headache, local back pain, temporary motor loss in lower extremities) was recorded. Results: 3 cases in blunt needle group and 8 cases in sharp needle group showed paresthesia during the procedure. The difference was not found to be significant among the groups. Vascular penetration was observed in 2 cases in blunt and 13 cases in sharp needle group and the difference between groups was statistically significant (p<0.001). Dural puncture and headache incidence were not significant when the two groups are compared. The local back pain at the injection site had a higher incidence in the blunt needle group. Conclusion: When using the blunt needles, vascular penetration and paresthesia were less during transforaminal epidural steroid injections. Therefore blunt needles seem to be more advantageous.

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Incidence of simultaneous epidural and vascular injection during lumbosacral transforaminal epidural injections

Cited by 80 publications

References 14 publications

Intraforaminal Location of Thoracolumbar Radicular Arteries Providing an Anterior Radiculomedullary Artery Using Flat Panel Catheter Angiotomography

Intraforaminal Location of Thoracolumbar Radicular Arteries Providing an Anterior Radiculomedullary Artery Using Flat Panel Catheter Angiotomography

A prospective study to evaluate the efficacies of low volume and high volume caudal epidural steroid injections in the treatment of lumbar degenerative disc disease

Comparison Of Blunt And Sharp Needles For Transforaminal Epidural Steroid Injections

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