Optimal Angle of Needle Insertion for Fluoroscopy‐Guided Transforaminal Epidural Injection of <scp>L</scp>5

Ra, In-Hoo; Min, Woo‐Kie

doi:10.1111/papr.12187

Cited by 5 publications

(8 citation statements)

References 17 publications

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“…[ 4 ] Therefore, we utilized an angle of 10° to 20°, which was smaller than the commonly used angle of L5 TFESI. [ 18 ] Then, in many cases, the block needle arrived in the sacral epidural space with less inward angle.…”

Section: Discussionmentioning

confidence: 99%

Comparison between anteroposterior and oblique “Scotty dog” approach during S1 transforaminal epidural steroid injection

Kang

Sim²,

Choi³

et al. 2020

Medicine

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Background: Traditionally, S1 transforaminal epidural steroid injection (TFESI) has been performed using an anteroposterior (AP) fluoroscopic view. In 2007, the oblique “Scotty dog” (OS) approach was introduced as an alternative technique. We compared passage time of the needle into S1 foramen (T f ) between the anteroposterior (AP) and oblique “Scotty dog” (OS) approach during S1 TFESI. Methods: In this prospective randomized controlled trial, seventy patients scheduled S1 TFESI were randomly allocated into AP or OS groups. In the AP group, a slight cephalad-caudad tilt was used. In the OS group, the C-arm was rotated ipsilateral oblique degrees to view the S1 Scotty dog. Both groups received injection of steroid mixed with local anesthetics. We measured the passage time of the needle into S1 foramen (T f ), primary outcome, and total procedure time (T t ) between the groups. We also recorded presence of intravascular injection, patients-assessed pain relief for one month and complications. Results: The T f and T t were shorter in the OS than in the AP group (24.4 ± 24.0 s vs 47. 8 ± 53.2seconds; 93.3 ± 35.0 seconds vs 160.0 ± 98.7 seconds, P < .001, both). Incidence of intravascular injection (AP, 8 [22.8%]; OS, 4 [11.4%], P = .205), pain score, and complication rates were not statistically different between the two groups. In logistic regression analysis, the body mass index (BMI) was a risk factor for longer T t (odds ratio [OR] = 1.27, 95% CI: 1.02–1.58, P = .030). Conclusion: The passage time of the needle into S1 foramen was shorter in OS approach and the OS approach reduced the procedure time compared with the AP approach during S1 TFESI. The practitioners should note that procedure time can be prolonged in obese patients.

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Section: Discussionmentioning

confidence: 99%

Comparison between anteroposterior and oblique “Scotty dog” approach during S1 transforaminal epidural steroid injection

Kang

Sim²,

Choi³

et al. 2020

Medicine

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“…Reconstruction of “safe” triangle or Kambin triangle may benefit the viability assessment of tESI, especially at the L5/S1 level. Ideally, needle trajectory is planned on an axial plane of conventional CT slices 10 . However, it could be difficult at the L5/S1 level for some cases due to the bony obstacles such as iliac crest, facet joint and transverse process (Figure 6).…”

Section: Discussionmentioning

confidence: 99%

“…Kambin triangle is defined as an anatomic triangle with the nerve root (hypotenuse), traversing nerve root and/or facet joint (height) and superior border of lower vertebrae (base) 9 . The “safe” triangle is defined as the lower margin of the pedicle (base), the lateral border of the vertebral body (height), and the outer border of the exiting nerve (hypotenuse) 10 . As the two triangles are three dimensional (3D), the targeted area of tESI is variable from different view or even totally concealed by bony structures, such as high iliac crest, enlarged transverse process and facet joint, especially at L5-S1 level 10-12 .…”

Section: Introductionmentioning

confidence: 99%

“…The “safe” triangle is defined as the lower margin of the pedicle (base), the lateral border of the vertebral body (height), and the outer border of the exiting nerve (hypotenuse) 10 . As the two triangles are three dimensional (3D), the targeted area of tESI is variable from different view or even totally concealed by bony structures, such as high iliac crest, enlarged transverse process and facet joint, especially at L5-S1 level 10-12 . An increased area of “safe” triangle and Kambin triangle should lead to more frequent successful outcomes of tESI 10 .…”

Section: Introductionmentioning

confidence: 99%

“…As the two triangles are three dimensional (3D), the targeted area of tESI is variable from different view or even totally concealed by bony structures, such as high iliac crest, enlarged transverse process and facet joint, especially at L5-S1 level 10-12 . An increased area of “safe” triangle and Kambin triangle should lead to more frequent successful outcomes of tESI 10 . Complications of tESI such as intravascular injection and nerve root injury are nightmare for operators 13, 14 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Deep Learning–Based Automatic Segmentation of Lumbosacral Nerves on CT for Spinal Intervention: A Translational Study

Fan

Liu

et al. 2019

AJNR Am J Neuroradiol

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Background and objective: Combined evaluation of lumbosacral structures (e.g. nerves, bone) on multimodal radiographic images is routinely conducted prior to spinal surgery and interventional procedures. Generally, magnetic resonance imaging is conducted to differentiate nerves, while computed tomography (CT) is used to observe bony structures. The aim of this study is to investigate the feasibility of automatically segmenting lumbosacral structures (e.g. nerves & bone) on non-contrast CT with deep learning. Methods: a total of 50 cases with spinal CT were manually labeled for lumbosacral nerves and bone with Slicer 4.8. The ratio of training: validation: testing is 32:8:10. A 3D-Unet is adopted to build the model SPINECT for automatically segmenting lumbosacral structures. Pixel accuracy, IoU, and Dice score are used to assess the segmentation performance of lumbosacral structures. Results: the testing results reveals successful segmentation of lumbosacral bone and nerve on CT. The average pixel accuracy is 0.940 for bone and 0.918 for nerve. The average IoU is 0.897 for bone and 0.827 for nerve. The dice score is 0.945 for bone and 0.905 for nerve. Conclusions: this pilot study indicated that automatic segmenting lumbosacral structures (nerves and bone) on non-contrast CT is feasible and may have utility for planning and navigating spinal interventions and surgery.

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The Effect of Skin Pressure on Needle Entry Point Accuracy During Fluoroscopically Guided Lumbar Transforaminal Epidural Injections

Yun

Yoon²,

Yoon³

et al. 2017

American Journal of Physical Medicine &Amp; Rehabilitation

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Optimal Angle of Needle Insertion for Fluoroscopy‐Guided Transforaminal Epidural Injection of L5

Abstract: When TFESI is performed at the L5 region in the prone position, placement of fluoroscopy at a cephalocaudal angle of 11.0° and an oblique angle of 25° in men and cephalocaudal angle of 13.9° and an oblique angle of 30° in women would be most reasonable.

Cited by 5 publications

References 17 publications

Comparison between anteroposterior and oblique “Scotty dog” approach during S1 transforaminal epidural steroid injection

Comparison between anteroposterior and oblique “Scotty dog” approach during S1 transforaminal epidural steroid injection

Deep Learning–Based Automatic Segmentation of Lumbosacral Nerves on CT for Spinal Intervention: A Translational Study

The Effect of Skin Pressure on Needle Entry Point Accuracy During Fluoroscopically Guided Lumbar Transforaminal Epidural Injections

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