Evaluation of Epidurographic Contrast Patterns with Fluoroscopic‐Guided Lumbar Interlaminar Ventral Epidural Injection

Choi, Young Kook; Barbella, Joseph D.

doi:10.1111/j.1533-2500.2009.00283.x

Cited by 22 publications

(21 citation statements)

References 24 publications

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“…Multiple prior studies have employed fluoroscopy to evaluate the dispersal pattern of injectate after interlaminar steroid injection. [6][7][8][9][10][11][12] The majority of these prior studies found the injected material remained more dorsal and unilateral in the epidural space. Assuming Lutz and colleagues to be correct, this may not be an optimal dispersal.…”

mentioning

confidence: 99%

Dispersal Pattern of Injectate after Lumbar Interlaminar Epidural Spinal Injection Evaluated with Computerized Tomography

Paisley

Jeffries

Monroe³

et al. 2012

Global Spine Journal

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Study Design Retrospective analysis of lumbar computed tomographic epidurograms. Objective To evaluate the dispersal pattern of injectate after interlaminar lumbar epidural steroid injections. Summary Prior studies have evaluated the dispersal patterns of injectate after lumbar epidural steroid injections using fluoroscopy with varying results. To date, there have been no studies evaluating the dispersal pattern utilizing computerized tomography. Methods Ten epidurograms were analyzed after lumbar interlaminar epidural steroid injection. The epidurograms were examined, evaluating the dispersal pattern in longitudinal flow as well as circumferential flow. In addition, pain values were assessed with the visual analogue scale. Results Mean diffusion in the rostral direction was 9.8 cm (standard deviation 4.0 cm, range 4.0 to 15.0 cm). Mean diffusion in the caudal direction was 5.4 cm (standard deviation 1.4 cm, range 3.0 to 8.0 cm). Both rostral and caudal flow had a p value < 0.001. The circumferential flow was 360 degrees in 9 of 10 cases. In addition, there was significant (p = 0.006) reduction in pain. Conclusion Interlaminar lumbar epidural steroid injections are an effective treatment modality for various spine-related conditions. The injectate diffuses throughout the epidural space with nearly uniform circumferential flow as well as significant rostral and caudal flow.

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mentioning

confidence: 99%

Dispersal Pattern of Injectate after Lumbar Interlaminar Epidural Spinal Injection Evaluated with Computerized Tomography

Paisley

Jeffries

Monroe³

et al. 2012

Global Spine Journal

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“…Concerns regarding the safety and effectiveness of TFESI have focused attention on alternative injection routes, including lateral parasagittal interlaminar (PIL) [2], inferior foraminal (targeting the inferior aspect of the foramen) [6], retrodiscal [4,5], and lumbar interlaminar ventral epidural (LIVE) approaches [3]. Candido et al [2] found the PIL approach to be superior to TFESI with respect to ventral contrast flow and effectiveness.…”

Section: Discussionmentioning

confidence: 99%

“…We find their conclusion to be in error, however, as the authors in fact compared PIL with the superoposterior intervertebral foraminal placement of a transforaminal injection [1]. Furthermore, although the injection was performed at the most lateral part of the interlaminar space, the depth of spreading into the ventral epidural space anterior to the nerve root and the dural sac by this route may be inconsistent [3]; and in rare instances, the PIL technique may result in nerve injury [19]. The inferior foraminal and retrodiscal approach directly targets the origin of pain, the disc-nerve interface, but requires care to avoid disc puncture, as it is essentially a discographic needle path [12].…”

Section: Discussionmentioning

confidence: 99%

“…The inferior foraminal and retrodiscal approach directly targets the origin of pain, the disc-nerve interface, but requires care to avoid disc puncture, as it is essentially a discographic needle path [12]. In one study using the LIVE approach [3], the catheter was placed correctly at the ventrolateral position of the nerve root in the gorge of the pedicle and the nerve root, but evaluation of the image in that publication did not clearly show nerve root filing.…”

Section: Discussionmentioning

confidence: 99%

“…However, pain generators in stenosis may differ from those involved in a central disc herniation [11]. To appropriately resolve inflammation and pain, and to prevent further recurrences, delivery of anti-inflammatory medications to all relevant target areas should be attempted [3]. …”

Section: Discussionmentioning

confidence: 99%

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Fluoroscopic analysis of lumbar epidural contrast spread after retrograde interlaminar ventral epidural injection (RIVEI)

Jeong

Shim

Woo

2013

Korean J Anesthesiol

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BackgroundRetrograde interlaminar ventral epidural injection (RIVEI) may hypothetically be more effective if the catheter is placed at the ventrocaudal aspect of the exiting nerve. We tested that hypothesis by measuring ventral and dorsal epidural contrast flow during RIVEI.MethodsTo perform RIVEI, a 17 G Tuohy needle was inserted to access the epidural space. A 19 G epidural catheter was inserted and advanced through the needle, passing in a caudal direction to the lower aspect of the contralateral pedicle. Fluoroscopic images were recorded at 1.5 ml increments of contrast. Based on the images of contrast dispersal, the extent of contrast spreading was assessed in 82 patients.ResultsAll 82 patients (100%) injected with 3.0 ml contrast medium demonstrated ventral epidural spreading. Mean spreading level from the catheter tip was 2.21 ± 0.93 with 3.0 ml of contrast. Spreading to the superior aspect of the supra-adjacent intervertebral disc was observed in 67/82 (81.7%) of RIVEIs with 3.0 ml of contrast injected into the ventral epidural space. We found that 3.0 ml of contrast reached the inferior aspect of the infra-adjacent intervertebral disc in 95.1% (78/82) of RIVEIs performed.ConclusionsOur findings imply that a one-level RIVEI may be sufficient in situations where a two-level injection would currently be used.

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CT-guided transforaminal epidural steroid injection for discogenic lumbar radiculopathy: influence of contrast dispersion and radiologist’s experience on clinical outcome

2021

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Objective To investigate the impact of contrast dispersion pattern/location during lumbar CT-guided transforaminal epidural steroid injection (TFESI) and experience of the performing radiologist on therapeutic outcome. Materials and methods In this single-center retrospective cohort study, two observers analyzed contrast dispersion during CT-guided TFESI of 204 patients (age 61.1 ± 14 years) with discogenic unilateral single-level L4 or L5 radiculopathy. The contrast dispersion pattern was classified as “focal,” “linear,” or “tram-track”; the location was divided into “extraforaminal,” “foraminal,” or “recessal.” Pain was assessed before and 4 weeks after treatment using a numerical rating scale (0, no pain; 10, intolerable pain). Additionally, the patient global impression of change (PGIC) was assessed. The TFESI was performed by musculoskeletal radiologists (experience range: first year of musculoskeletal fellowship training to 19 years). Contrast pattern/location and radiologist’s experience were compared between “good responder” (≥ 50% pain reduction) and “poor responder” (< 50%). A p-value < 0.05 was considered to be statistically significant. Results Overall, CT-guided TFESI resulted in a substantial pain reduction in 46.6% of patients with discogenic radiculopathy. The contrast dispersion pattern and location had no effect on pain relief (p = 0.75 and p = 0.09) and PGIC (p = 0.70 and p = 0.21) 4 weeks after TFESI. Additionally, the experience of the radiologist had no influence on pain reduction (p = 0.92) or PGIC (p = 0.75). Regarding pre-interventional imaging findings, both the location and grading of nerve compression had no effect on pain relief (p = 0.91 and p = 0.85) and PGIC (p = 0.18 and p = 0.31). Conclusion Our results indicate that neither contrast agent dispersion/location nor the experience of the radiologist allows predicting the therapeutic outcome 4 weeks after the procedure.

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Evaluation of Epidurographic Contrast Patterns with Fluoroscopic‐Guided Lumbar Interlaminar Ventral Epidural Injection

Abstract: The data showed excellent spread of contrast into the nerve root and the ventral epidural space in all patients. There were no inadvertent vascular or neural complications. LIVE approach can be an alternative way to achieve targeted ventral epidural injection.

Cited by 22 publications

References 24 publications

Dispersal Pattern of Injectate after Lumbar Interlaminar Epidural Spinal Injection Evaluated with Computerized Tomography

Dispersal Pattern of Injectate after Lumbar Interlaminar Epidural Spinal Injection Evaluated with Computerized Tomography

Fluoroscopic analysis of lumbar epidural contrast spread after retrograde interlaminar ventral epidural injection (RIVEI)

CT-guided transforaminal epidural steroid injection for discogenic lumbar radiculopathy: influence of contrast dispersion and radiologist’s experience on clinical outcome

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