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| 21KF-051 |
Effect of Injectate Viscosity on Epidural Distribution in Lumbar Transforaminal Epidural Steroid Injection
Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Republic of Korea,
Introduction. There is no report on the effect of injectate viscosity on epidural distribution for lumbar transforaminal epidural steroid injections (L-TFESIs). The aim of this study was to evaluate the influence of injectate viscosity on the volume needed to reach specific landmarks in L-TFESIs.
Methods. A prospective, randomized, comparative human study involving 118 patients undergoing L-TFESIs was conducted. The study subjects were divided into two groups by a random selection method: raw viscosity group (RV, n=58) and low viscosity group (LV, n=60). Contrast volumes were recorded as the contrast flow reached specific anatomical landmarks under fluoroscopic guidance.
Results. The possibility of delivering the injectate to each landmark showed a positive correlation with the amount and a negative correlation with the viscosity of the injectate. However, for landmarks at the medial aspect of the superior pedicle of the corresponding level of injection and for those beyond the spinous process over the contralateral spinal segment, the influence of viscosity was not statistically significant.
Conclusion. The epidural distribution of the contrast agent through the transforaminal approach was most affected by the injectate volume and was also partly affected by the viscosity.
Figure 1
Dot plots and trendlines reaching specific landmarks in each group. RV: group of raw viscosity, LV: group of low viscosity, PED: the medial aspect of the superior pedicle of the corresponding level of injection, SIVD: the superior aspect of the superior intervertebral disc of the corresponding level of injection, IIVD: the inferior aspect of the inferior intervertebral disc of the corresponding level of injection, MID: beyond the midline, spinous process, of the contralateral spinal segment.
Figure 2
Radar plots over a sample of lumbar spine anteroposterior view, which represent the possibility of reaching by amount in the two groups. (a) is the result of the RV group, and (b) is the result of the LV group. “1,” upper vertex, is corresponding to the landmark of SIVD. “2,” right vertex, is to PED. “3,” lower vertex, is to IIVD, and “4,” left vertex, is to MID. For example, the rhombus of a solid black line indicates a point in which a 0.5eached. This rhombus is wider at B than at A. This means that the injectate with a lower viscosity at the same amount can be more distantly distributed. In the radar plot based on anatomic landmarks set in this study, each vertex represents a reachable point, and the area of rhombus does not reflect the actual wideness of distribution.
Methods. A prospective, randomized, comparative human study involving 118 patients undergoing L-TFESIs was conducted. The study subjects were divided into two groups by a random selection method: raw viscosity group (RV, n=58) and low viscosity group (LV, n=60). Contrast volumes were recorded as the contrast flow reached specific anatomical landmarks under fluoroscopic guidance.
Results. The possibility of delivering the injectate to each landmark showed a positive correlation with the amount and a negative correlation with the viscosity of the injectate. However, for landmarks at the medial aspect of the superior pedicle of the corresponding level of injection and for those beyond the spinous process over the contralateral spinal segment, the influence of viscosity was not statistically significant.
Conclusion. The epidural distribution of the contrast agent through the transforaminal approach was most affected by the injectate volume and was also partly affected by the viscosity.
Figure 1
Dot plots and trendlines reaching specific landmarks in each group. RV: group of raw viscosity, LV: group of low viscosity, PED: the medial aspect of the superior pedicle of the corresponding level of injection, SIVD: the superior aspect of the superior intervertebral disc of the corresponding level of injection, IIVD: the inferior aspect of the inferior intervertebral disc of the corresponding level of injection, MID: beyond the midline, spinous process, of the contralateral spinal segment.
Figure 2
Radar plots over a sample of lumbar spine anteroposterior view, which represent the possibility of reaching by amount in the two groups. (a) is the result of the RV group, and (b) is the result of the LV group. “1,” upper vertex, is corresponding to the landmark of SIVD. “2,” right vertex, is to PED. “3,” lower vertex, is to IIVD, and “4,” left vertex, is to MID. For example, the rhombus of a solid black line indicates a point in which a 0.5eached. This rhombus is wider at B than at A. This means that the injectate with a lower viscosity at the same amount can be more distantly distributed. In the radar plot based on anatomic landmarks set in this study, each vertex represents a reachable point, and the area of rhombus does not reflect the actual wideness of distribution.
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