The feasibility of color Doppler ultrasonography for caudal epidural steroid injection

Abstract

Although it entails a radiation hazard risk, the use of fluoroscopy during caudal epidural steroid injection has increased to help place the medication more accurately and allowed physicians to maximize the procedure's therapeutic success rate. To investigate the feasibility of using real-time high resolution ultrasonography for guiding the epidural needle into the caudal epidural space and to confirm any vascular intake of medication, we performed color Doppler ultrasonography while medication was being injected into the caudal epidural space of 53 patients with low back pain and sciatica. We defined the injection as being successful if unidirectional flow (observed as one dominant color) of the solution was observed with color Doppler ultrasonography through the epidural space beneath the sacrococcygeal ligament, with no flows being observed in other directions (observed as multiple colors). The correct placement of the medication was then confirmed by fluoroscopy. In 52 of the 53 subjects, the medications were successfully injected into the caudal epidural space with ultrasonography assistance. In fluoroscopy, of these 52 patients, 50 revealed correct placement of the medicine into the epidural space. In conclusion, ultrasonography may be a reliable imaging modality for caudal epidural steroid injection, and its several advantages such as its convenience and the lack of a radiation hazard, make it preferable to fluoroscopy.

Anatomic Differences in the Sacral Hiatus During Caudal Epidural Injection Using Ultrasound Guidance

“…Finally, we did not perform color Doppler imaging during injection, which may be helpful for detecting intravascular injection during the procedure. 22 In conclusion, our results corroborate previous studies by describing an ultrasound method for identifying anatomic landmarks of the sacral hiatus to guide successful caudal epidural steroid injection. Ultrasound imaging is a useful method that can be used not only to detect anatomic landmarks but also to guide needle placement during this procedure.…”

Ultrasound Guided Spine Injections: Advancement Over Fluoroscopic Guidance?

“…The use of corticosteroid injections to the epidural space has been used for decades for the treatment of pain secondary to lumbar, thoracic, and cervical pathologies [20,21]. They are commonly used for the treatment of single and multilevel pathology, spondylolisthesis, spinal stenosis, or radiculopathy.…”

“…Yoon et al [20] studied the feasibility of using real-time high resolution US for guiding the spinal needle into the caudal epidural space as well as confirming epidural flow of medication with color Doppler US in 53 patients. Fortyseven of the 53 subjects had a positive flow spectrum and 50 of the 52 subjects with positive Doppler change, had fluoroscopic confirmation.…”

Efficacy of epidural steroid injection of patients with back pain dependant to lombar disc hernia; prospective, clinical study

“…Ayrıca paraspinal kas spazmını ve lumbaljili hastaların %10'unda bulunan refleks sempatik distrofiyi de ortadan kaldırır (10). Yapılan çalışmalarda L4-L5 aralığına verilen 6 ml radyoopak maddenin L1 ve S5 arasında yayıldığı gözlenmiştir (11). Bu nedenle klinikte en sık kullanılan 10 ml'lik volüm patolojinin olduğu tüm epidural bölgeye yayılmaktadır (10).…”