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KMID : 1040020100010010035
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International Journal of Pain
2010 Volume.1 No. 1 p.35 ~ p.41
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A Comparison of Contrast Patterns of Lumbar Transforaminal Injection with Different Volumes
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Cho Hye-Won
Lee Ji-Yong
Choi Won-Hyeong
Choi Jeong-Ju
Han Kyung-Ream
Kim Chan
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Abstract
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Background: Lumbar transforaminal epidural injections (LTEIs) have been widely utilized in the treatment of radicular pain. LTEIs are considered to be the most target-specifi c; therefore, the least volume of injectate is required to reach the primary site of pathology. However, there have been no studies on the proper volume of injection needed in LTEIs. We studied the contrast spreading patterns of LTEIs with 1 ml, 2 ml, or 3 ml volume of the mixture with contrast media and normal saline.
Methods: A total of 65 patients with spine or non-spine diseases were enrolled. Fluoroscopic guided LTEIs were performed consecutively with 1 ml (n = 16), 2 ml (n = 17) and 3 ml (n = 32) volumes of mixture containing 2 ml of Iopamidol (0.7552 g/ml) and 1 ml of normal saline. Patterns were recorded as a nerve root fi lling, a nerve root fi lling with unilateral epidural spreading or a nerve root fi lling with bilateral epidural spreading. A number of cephalad or caudad vertebral spreading segments of contrast media were recorded as well.
Results: Total vertebral spreading segments of contrast media were not signifi cantly different between each group. The number of patients with limited contrast fl ow to the targeted single vertebral level was signifi cantly higher in the 1 ml and 2 ml groups than in 3 ml group. There was no difference in the number of patients with only nerve root fi lling among the three groups. Only four (6.1%) of the 65 total patients showed nerve root fi lling. Most of the patients in the 1 ml and 2 ml groups showed nerve root fi lling with unilateral epidural spreading. A fraction of the pattern of nerve root fi lling with bilateral epidural spreading was signifi cantly different between 1 ml and 3 ml groups.
Conclusions: An injectate volume less than 2ml would be adequate for selectively covering the targeted single nerve root and ipsilateral epidural space of pathologic segmental level in LTEIs. An injectate volume less than 1 ml is needed when performing diagnostic LTEIs to selectively spread injectate around the targeted nerve root.
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KEYWORD
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contrast patterns, lumbar transforaminal epidural injection, volume
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