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21KF-036
Correlation between the Extent of Injectate Spread and Clinical Outcomes in Cervical Interlaminar Epidural Injection
Hyo Jin YeonMin Cheol Rho, Young Hoon Kim
Department of Anesthesiology and Pain Medicine, Seoul St. Marys Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Background
Cervical interlaminar epidural injection (CILEI) is known as an effective treatment to treat acute and chronic pain involving head, neck, and upper extremity. Few studies have analyzed the correlation between epidurography and clinical outcomes. The purpose of this study is to evaluate the association between the diffusion pattern of contrast medium and the degree of pain relief after CILEI.
Methods
A successful outcome was defined as a ≥50% reduction in the numeric rating scale (NRS) for pain at 4 weeks after the CILEI. Patient demographics, duration of symptoms and radiographic findings including simple radiograph and cervical magnetic resonance imaging were also analyzed. Contrast spread patterns were classified into a total of 4 categories using the medial border, bisector and lateral border of articular pillar as anatomical reference points at the target level in the anteroposterior view of fluoroscopy. Presence of contrast on ventral epidural space at the target lesion was also determined in the lateral fluoroscopic view.
Results
Of the 130 patients, 78 (60%) patients had successful results 4 weeks after CILEI. The mean NRS for pain decreased from 7.2 to 2.5 in the successful group, and from 6.9 to 5.6 in the unsuccessful group. According to multivariable logistic regression analysis, the negative predictors of CILEI were the symptom duration (P = 0.045), the higher grade of central stenosis (P = 0.022), and the restricted spread of the contrast medium within the dorsal epidural space (DES) in the fluoroscopy anteroposterior view (P = 0.008).
Conclusion
Long duration of symptom, severe central stenosis and the restricted spread of the contrast medium within the DES may result in poor outcomes after CILEI. Therefore, it could be clinically important to allow the contrast agent to reach the dorsal root ganglion of the target level as well as the DES during CILEI.
References
1. Goldstein CL et al. Global Spine J 2019; 9(4); 393-7.
2. Yabuki S and Kikuchi S. Spine (Phila Pa 1976); 21(13); 1513-7.