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KMID : 0948920100090010016
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Clinical Pain
2010 Volume.9 No. 1 p.16 ~ p.20
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Vascular Contrast Patterns in Cervical Transforaminal Epidural Steroid Injections: Frequency and Relationship with the Needle Tip Position
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Min Yu-Sun
Chun Seong-Min
Chung Sun-Gun
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Abstract
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Objective : To determine the incidence of vascular penetration during cervical transforaminal epidural steroid injection and to reveal the relationship between the incidence of vascular penetration and the needle tip positions in the neural foramen.
Materials and Methods: The study included 146 transforaminal epidural steroid injections performed on 109 patients in a rehabilitation outpatient clinic. Using fluoroscopic guidance, a 25 gauge needle was placed into the epidural space using a transforaminal approach according to the accepted standard technique. During the procedure, intermittent fluoroscopy images were saved for each significant needle position. Contrast patterns were examined with real-time fluoroscopic surveillance and the resulting images were also stored. The incidence of vascular penetration and the relationship between the incidence and needle tip locations in the neural foramen were analyzed retrospectively. The vascular penetration patterns were categorized as one of followings: vertebral artery, radicular artery and venous plexus. The needle tip positions were classified as upper, middle and lower.
Results: The overall rate of intravascular penetration was 28.1%. The patterns of intravascular penetration showed the vertebral artery (9.7%), radicular artery (4.9%) and venous plexus (85.4%). There was no significant difference in the incidence of intravascular penetration depending on the needle tip positions.
Conclusion: Intravascular penetration occurred in about one thirds of the cervical transforaminal epidural steroid injections. The most common vascular structure being in-advertently penetrated was the venous plexus, followed by the vertebral and radicular artery. No significant correlation was found between the incidence of vascular penetration patterns and needle tip positions. However, further studies with larger sample sizes are required for a more meaningful determination.
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KEYWORD
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Cervical, Intravascular, Transforaminal, Epidural injection, Radicular pain
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