Incidence of Simultaneous Epidural and Vascular Injection During Cervical Transforaminal Epidural Injections

Abstract

Simultaneous epidural and vascular injection accounts for over half of all vascular injections during cervical transforaminal epidural injections. With the risk of severe complications and high incidence of vascular injections in the cervical spine, live fluoroscopy is recommended during contrast injection with specific attention to simultaneous epidural and vascular flow.

CT-Fluoroscopic Cervical Transforaminal Epidural Steroid Injections: Extraforaminal Needle Tip Position Decreases Risk of Intravascular Injection

“…We were able to evaluate intravascular injection of the steroid/analgesic cocktail because we routinely mix iodinated contrast with our cocktail, a procedural technique detail not practiced at many other institutions. In previous descriptions of CT-guided 3,10,11 and conventional fluoroscopic-guided [12][13][14][15] injections, the intravascular contrast was always identified on the trial dose and the needle was appropriately readjusted before injecting the steroid/analgesic cocktail. Many of our intravascular injections were trace volume, had a very subtle appearance, were not noted at the time of the procedure, and were identified only with meticulous retrospective evaluation of the procedural imaging.…”

“…4 The intravascular injection rate for CT-guided cervical TFESIs has previously been estimated at 1%-26%, 3,10,11 while the corresponding rate for conventional fluoroscopic guidance has been published at 17%-32.8%. [12][13][14][15] Despite the known risks of the procedure and the high anatomic resolution of CT, the role of needle position in intravascular injection has not been previously evaluated, to our knowledge. The purpose of this study was to determine the safest needle tip depth relative to the targeted neural foramen as determined by the incidence of intravascular injection.…”

Epidural glucocorticoid use for vertebrogenic pain

“…При интерлами-нарном введении используется меньшее количество препа-рата и ниже риск повреждения твердой мозговой оболочки, чем при каудальном. Трансфораминальный путь позволяет доставить лекарство непосредственно к поврежденному нер-вному корешку, что в свою очередь связано с риском повреж-дения корешка и развития острой радикулопатии [10]. Ряд авторов считает каудальный путь наиболее безопасным [7].…”

Spinal Injections for Pain Management

“…Patients who cannot lie in the prone position may be able to tolerate intravenous needle placements are more common in patients with cervical NRBs (incidence range, 19.4%-32.8%) than in those with lumbar NRBs (incidence range, 11.2%-13.1%), but actual incidence depends on injection level (10-13). In the cervical spine, vascular cannulation is more likely from C3-4 to C5-6 (range, 40%-57%) (13). In the lumbosacral spine, it is more than twice as likely at S1 (21.3% incidence) compared to lumbar levels (8.1% incidence) (10)(11)(12).…”

“…They found needle misplacements in 25%-38% of blind procedures performed by experienced injectionists (7)(8)(9). Epidurography was necessary to confirm injectate location and to exclude intravascular or intrathecal administration (10)(11)(12)(13).…”