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KMID : 1140920170410030413
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Annals of Rehabilitation Medicine
2017 Volume.41 No. 3 p.413 ~ p.420
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Contrast Spread in the Superoposterior Approach of Transforaminal Epidural Steroid Injections for Lumbosacral Radiculopathy
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Jeong Young-Cheol
Lee Chung-Ho
Kang Seok
Yoon Joon-Shik
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Abstract
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Objective: To observe the contrast spread in superoposterior transforaminal epidural steroid injection (SP TFESI) and investigate the correlation between spread patterns and efficacy.
Methods: Thirty-one patients with lumbosacral radiculopathy underwent single-level TFESI under fluoroscopy. The final needle tip position was targeted toward the SP quadrant of the intervertebral foramen. To observe the spread, 1 mL of contrast material was injected, followed by a steroid injection. The contrast spread was graded anteroposteriorly and vertically in the epidural space. The effect of SP TFESI was evaluated by proportional pain score reduction.
Results: Levels injected were L4-5 (n=20) and L5-S1 (n=11). Seventeen cases were lateral, and 14 were central herniated disc (HD). Baseline mean visual analog scale score was 6.23. Contrast dispersed dorsally in all the cases, and 45.2% cases showed a concurrent ventral spread. The proportion of the pain reduction after 2 weeks showed no difference between the two groups. In vertical spreading analysis, mean cephalic/caudal grades were 1.40/1.55 at L4-5 level and 1.73/1.64 at L5-S1 level. The HD location had no effect on contrast dispersion.
Conclusion: In SP TFESI, ventral contrast spread did not guarantee a better effect; however, the extent of cephalic flow in ventral expansion group correlated with the proportion of pain reduction.
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KEYWORD
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Epidural injection, Contrast media, Lumbosacral, Radiculopathy, Treatment outcome
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