초록접수[미리보기]
| 21KF-014 |
Measurement of Depth of S1 foramen for ultrasound-guided S1 Transforaminal Epidural Injection
Department of Anesthesiology and Pain Medicine, Jeonbuk National
University Hospital and Medical School, Jeounju, Republic of Korea
Background
Ultrasound-guided 1st sacral (S1) transforaminal epidural injection (TFEI) is a useful method that can be easily performed in outpatient and bedside without radiation exposure, and it also can observe the needle pathway in real-time. In general, the out-of-plane approach is used. During injection, if the needle is inserted too shallowly, the drug may leak out, and if it is too deep, the drug may leak through the ventral sacral foramen.
The purpose of this study is to evaluate the radiological information of the S1 foramen using CT images for better Ultrasound-guided S1 TFEI performance.
Materials and Methods
This study retrospectively reviewed 288 consecutive adult patients, aged 19 to 99 years, who underwent spiral CT 3D Hip due to trauma or diseases from January 2019 to February 2021. The following cases were excluded from the study: 1. Difficult to measurement of 1st dorsal sacral foramen because of fixation by pins for lumbosacral fracture. 2. Deformity by cancer or metastatic bone region. 3. Severe degenerative change.
Measurement : The following parameters were measured, using spiral 3D-CT Hip scan axial images. A) the depth of S1 (S1D ;mm) is defined as a length from the dorsal sacral surface to the epidural space of the S1 dorsal foramen. B) the width of S1 (S1W ;mm) is defined as a largest diameter of the S1 dorsal foramen. C) the angle of S1 (S1A ;°) is defined as an angle between S1 dorsal foramen and the sagittal horizon in axial plane. D) the distance of S1 (S1ds ;mm) is defined as the length between the line passing through the center of the sacrum and the parallel line through the center of the S1 dorsal foramen.
A linear regression model was used to further analyze the relationship between potential demographic predictors and measured values.
Results
A total of 288 patients, who were 129 males and 159 females were analyzed on both side, and 7 were excluded due to severe degenerative change(4), deformity(2) or fracture(1).
The S1D was measured to be 11.97 ± 2.00 mm in males and 10.94 ± 1.92 mm in females (p<0.001). The S1A was 27.13 ± 4.29 ° in males and 29.18 ± 4.99 ° in females (p<0.001). The S1ds was found to be 24.38 ± 2.81 mm in males and 23.57 ± 2.78 mm in females (p<0.05), whereas the S1W (p=0.108) showed no significant difference according to sex.
In univariate analysis, age (R=-0.319, p<0.001) and height (R=0.391, p<0.001), weight (R=0.232, p<0.05) were significant predictors for S1D. S1D decreased with age and increased with height and weight.
In multivariate analysis, only height (R=0.433, p<0.05) has been demonstrated to be a significant predictor of S1D.
Conclusion
This study evaluated the detailed information of the S1 foramen, and suggests adjusting the needle insertion depth according to the patient’s height when performing ultrasound-guided S1-TFEI with an out-of-plane approach.
Ultrasound-guided 1st sacral (S1) transforaminal epidural injection (TFEI) is a useful method that can be easily performed in outpatient and bedside without radiation exposure, and it also can observe the needle pathway in real-time. In general, the out-of-plane approach is used. During injection, if the needle is inserted too shallowly, the drug may leak out, and if it is too deep, the drug may leak through the ventral sacral foramen.
The purpose of this study is to evaluate the radiological information of the S1 foramen using CT images for better Ultrasound-guided S1 TFEI performance.
Materials and Methods
This study retrospectively reviewed 288 consecutive adult patients, aged 19 to 99 years, who underwent spiral CT 3D Hip due to trauma or diseases from January 2019 to February 2021. The following cases were excluded from the study: 1. Difficult to measurement of 1st dorsal sacral foramen because of fixation by pins for lumbosacral fracture. 2. Deformity by cancer or metastatic bone region. 3. Severe degenerative change.
Measurement : The following parameters were measured, using spiral 3D-CT Hip scan axial images. A) the depth of S1 (S1D ;mm) is defined as a length from the dorsal sacral surface to the epidural space of the S1 dorsal foramen. B) the width of S1 (S1W ;mm) is defined as a largest diameter of the S1 dorsal foramen. C) the angle of S1 (S1A ;°) is defined as an angle between S1 dorsal foramen and the sagittal horizon in axial plane. D) the distance of S1 (S1ds ;mm) is defined as the length between the line passing through the center of the sacrum and the parallel line through the center of the S1 dorsal foramen.
A linear regression model was used to further analyze the relationship between potential demographic predictors and measured values.
Results
A total of 288 patients, who were 129 males and 159 females were analyzed on both side, and 7 were excluded due to severe degenerative change(4), deformity(2) or fracture(1).
The S1D was measured to be 11.97 ± 2.00 mm in males and 10.94 ± 1.92 mm in females (p<0.001). The S1A was 27.13 ± 4.29 ° in males and 29.18 ± 4.99 ° in females (p<0.001). The S1ds was found to be 24.38 ± 2.81 mm in males and 23.57 ± 2.78 mm in females (p<0.05), whereas the S1W (p=0.108) showed no significant difference according to sex.
In univariate analysis, age (R=-0.319, p<0.001) and height (R=0.391, p<0.001), weight (R=0.232, p<0.05) were significant predictors for S1D. S1D decreased with age and increased with height and weight.
In multivariate analysis, only height (R=0.433, p<0.05) has been demonstrated to be a significant predictor of S1D.
Conclusion
This study evaluated the detailed information of the S1 foramen, and suggests adjusting the needle insertion depth according to the patient’s height when performing ultrasound-guided S1-TFEI with an out-of-plane approach.
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