The 68th
Scientific Meeting
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| 19S-058 |
Incidence of Intra-articular Facet Joint Injection during Fluoroscopy-guided Cervical Interlaminar Epidural Injections.
Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea.
BACKGROUND AND PURPOSE: We sometimes encounter inadvertent intrafacet injection during cervical interlaminar epidural injection, which leads to false-positive epidural injection. The purposes of this study were to evaluate the rate of inadvertent intrafacet injection and to investigate various factors associated with inadvertent injection into the space of Okada during fluoroscopy-guided cervical interlaminar epidural injection.
MATERIALS AND METHODS: Images from consecutive cases of fluoroscopy-guided cervical interlaminar epidural injection performed at a single institution between July 2015 and July 2018 were obtained and reviewed. Cases of epidural injection were classified as either facet injection or no facet injection. Multivariate logistic regression was used to identify the predictive factors of inadvertent injection into the Okada space.
RESULTS: A total of 1,156 fluoroscopy-guided cervical interlaminar epidural injections were included. Inadvertent intrafacet injection was identified in 7.5% of cases (81/1,156). All cases of inadvertent intrafacet injection were recognized and appropriate epidurograms were obtained during the procedures. The highest rate of inadvertent intrafacet injection (11.5% [31/270]) occurred at C5-6. Cervical interlaminar epidural injection at C5-6 and above (adjusted OR = 1.79; P = 0.01) and the paramidline approach for epidural injection (adjusted OR = 2.29; P = 0.001) were associated with inadvertent injection into the retrodural space of Okada.
CONCLUSIONS: We detected inadvertent injection into the retrodural space of Okada during fluoroscopy-guided cervical interlaminar epidural injection in 7.5% of procedures. Cervical interlaminar epidural injection at C5-6 and above and the paramidline approach for epidural injection were positive predictors of inadvertent intrafacet injection.
1. Manchikanti L, Nampiaparampil DE, Candido KD, et al. Do cervical epidural injections provide long-term relief in neck and upper extremity pain? A systematic review. Pain physician 2015;18:39-60
2. Choi JW, Lim HW, Lee JY, et al. Effect of Cervical Interlaminar Epidural Steroid Injection: Analysis According to the Neck Pain Patterns and MRI Findings. The Korean journal of pain 2016;29:96-102
MATERIALS AND METHODS: Images from consecutive cases of fluoroscopy-guided cervical interlaminar epidural injection performed at a single institution between July 2015 and July 2018 were obtained and reviewed. Cases of epidural injection were classified as either facet injection or no facet injection. Multivariate logistic regression was used to identify the predictive factors of inadvertent injection into the Okada space.
RESULTS: A total of 1,156 fluoroscopy-guided cervical interlaminar epidural injections were included. Inadvertent intrafacet injection was identified in 7.5% of cases (81/1,156). All cases of inadvertent intrafacet injection were recognized and appropriate epidurograms were obtained during the procedures. The highest rate of inadvertent intrafacet injection (11.5% [31/270]) occurred at C5-6. Cervical interlaminar epidural injection at C5-6 and above (adjusted OR = 1.79; P = 0.01) and the paramidline approach for epidural injection (adjusted OR = 2.29; P = 0.001) were associated with inadvertent injection into the retrodural space of Okada.
CONCLUSIONS: We detected inadvertent injection into the retrodural space of Okada during fluoroscopy-guided cervical interlaminar epidural injection in 7.5% of procedures. Cervical interlaminar epidural injection at C5-6 and above and the paramidline approach for epidural injection were positive predictors of inadvertent intrafacet injection.
1. Manchikanti L, Nampiaparampil DE, Candido KD, et al. Do cervical epidural injections provide long-term relief in neck and upper extremity pain? A systematic review. Pain physician 2015;18:39-60
2. Choi JW, Lim HW, Lee JY, et al. Effect of Cervical Interlaminar Epidural Steroid Injection: Analysis According to the Neck Pain Patterns and MRI Findings. The Korean journal of pain 2016;29:96-102
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