Lumbar epidurography with metrizamide.

Hatten, H P

doi:10.1148/radiology.137.1.7422834

Cited by 28 publications

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“…Metrizamide, a nonionic approved by the FDA for myelography in 1978 was used to visualize the lumbar epidural space in the 1980's. Hatten (11) proposed epidurography is a valuable tool providing clinicians with important anatomical information in evaluation of patients with equivocal myelography and or confusing or non-diagnostic physical findings.…”

Section: Discussionmentioning

confidence: 99%

Fluoroscopic Guided Lumbar Interlaminar Epidural injections: A Prospective Evaluation of Epidurography Contrast Patterns and Anatomical Review of the Epidural Space

Botwin

Natalicchio²,

Hanna³

2004

Pain Phys

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To evaluate the pattern and flow of epidural contrast in fluoroscopically guided lumbar interlaminar steroid injections.Design and Methods: A prospective case series of 25 (twenty-five) consecutive patients receiving 25 (twenty-five) injections. Patients had either lumbar spinal stenosis (LSS) or herniated nucleus pulposus (HNP). All patients received their injection using a loss of resistance technique. Once the epidural space was felt localized 0.5 mL of Isovue contrast was injected to confirm accurate needle placement. If in the epidural space, another 4.5 mL was injected for a total of 5 mL contrast media. Both AP and lateral radiographs were obtained and reviewed by a physician trained in fluoroscopic injections for review of the contrast pattern. Patterns recorded were Unilateral, Bilateral, Ventral or Dorsal. The dorsal flow was also characterized as being cephalad or caudad and the number of lumbar intervertebral levels of flow were recorded as well.Results: Dorsal contrast flow occurred in all 25 injections. Thirty-six percent (9 out of 25) resulted in ventral spread of contrast. Eighty-four percent (21 out of 25) of the injections had flow of contrast unilaterally and 16% (4 out of 25) was bilateral. The mean number of levels of flow of contrast cephalad from the injection site was 1.28 and caudally 0.88. There was a significant difference in more cephalad than caudal contrast flow (P = 0.004) Conclusion: Thirty six percent of the injections observed in the study revealed ventral contrast flow. Bilateral contrast flow occurred in 16% of the injections. Caudad contrast flow is less than cephalad. The observed contrast flows need to be studied clinically to determine if this can affect clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Fluoroscopic Guided Lumbar Interlaminar Epidural injections: A Prospective Evaluation of Epidurography Contrast Patterns and Anatomical Review of the Epidural Space

Botwin

Natalicchio²,

Hanna³

2004

Pain Phys

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“…For this reason, it has been advocated that needle placement should be confirmed by fluoroscopy alone [2] or epidurography [4], and successful entry into the epidural space has been reported in 97.5% using this latter technique [4]. The practical and logistical difficulties that this entails are not inconsiderable, and the complications of epidurography have been reported as similar to those of myelography [5], (although with the small volumes required to confirm needle position these complications are less likely). Hence the attraction of a simple clinical test to confirm the needle position.…”

Section: Discussionmentioning

confidence: 99%

The ‘whoosh’ test

Lewis

Thomas²,

Wilson

et al. 1992

Anaesthesia

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SummaryWe describe a previously unreported test to confirm accurate needle placement in caudal epidurals. Of 26 patients undergoing caudal epidural, 19 (73%) had correct needle placement as determined by epidurography. AN of these had a positive 'whoosh' test. There were no false positives. Key wordsAnaesthetic techniques, regional; caudal.Epidural injections of local anaesthetic agents and corticosteroids are widely used to provide symptomatic relief in patients suffering from low back disorders. The caudal route, although theoretically safer in that the risk of dural puncture is small, has the disadvantage that needle placement is less certain. We describe a clinical test to confirm the position of the needle in the epidural space, and assess the accuracy of the method using epidurography on a series of patients. MethodsPatients who were suffering from low back pain and sciatica were studied. Any patient having a contraindication to contrast media or radiological investigation was excluded from the study. Blood pressure and pulse measurements were made with the patient supine; they were then placed in the prone position and, under aseptic conditions, the sacral hiatus was palpated and the skin infiltrated with local anaesthetic (lignocaine 1% 2 ml). A 21G needle was inserted through the sacrococcygeal membrane, and aspiration performed to ensure that the needle had not penetrated a blood vessel or the dura. The operator then applied a stethoscope over the thoracolumbar region in the midline and listened as a volume of approximately 2 ml of air was injected. Our hypothesis was that if the needle was truly in the epidural space; then a 'whoosh' heard with the stethoscope upon injection would confirm the passage of air proximally in the epidural space; a positive test. Conversely, a needle position that lay outside the epidural space would not produce such a sound; a negative test.The position of the needle was confirmed by injecting 5 ml of contrast medium (Niopam 300) and taking plain X rays (AP and lateral) to detect the presence of contrast in the epidural space. If the position was confirmed, the therapeutic injection was performed; otherwise the needle was withdrawn and resited. Afterwards the patient was admitted to hospital overnight and routine observations performed. ResultsA total of 26 patients were included in the study ( Table 1). There were seven patients classified clinically as obese; six women (mean weight 81 kg) and one man (weight 117 kg). Of these patients, three had a positive test confirmed by epidurography. The other four patients had needle positions outside the sacral hiatus, confirming the difficulty of needle placement in obese patients. However, instead of a silent 'whoosh' test the operator heard a high pitched crackling sound with the stethoscope and was able to palpate air in the subcutaneous fat. This small series showed the 'whoosh' test to be both specific and sensitive. DiscussionThe caudal route of entry to the epidural space is preferred to the lumbar route by many practitio...

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“…This aspect is presently under investigation. Hatten (1980) has described a technique of introducing .metrizamide through a catheter placed in the epidural space via the sacral hiatus. Ideally the tip of the catheter can be placed precisely at the level of interest in the lumbar spine, and an optimum volume of contrast injected.…”

Section: Discussionmentioning

confidence: 99%

Metrizamide Epidurography

Hamilton

1983

J R Soc Med

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The results are reported of lumbar epidurography in 110 patients suffering from low back pain. By using the water-soluble non-ionic contrast metrizamide, it has been possible to perform the examination on an outpatient basis. None of the patients has suffered from headache, nor any other complaint often associated with other diagnostic techniques which involve lumbar puncture. Epidurography is sufficiently accurate to be regarded as the examination of choice in the diagnosis of lumbar disc prolapse.

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Lumbar epidurography with metrizamide.

Cited by 28 publications

References 0 publications

Fluoroscopic Guided Lumbar Interlaminar Epidural injections: A Prospective Evaluation of Epidurography Contrast Patterns and Anatomical Review of the Epidural Space

Fluoroscopic Guided Lumbar Interlaminar Epidural injections: A Prospective Evaluation of Epidurography Contrast Patterns and Anatomical Review of the Epidural Space

The ‘whoosh’ test

Metrizamide Epidurography

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