게시판
| 21KS-023 |
Comparison of Contrast Flow Between Subpedicular and Retrodiscal Approach of Lumbar Transforaminal Epidural Injections
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Introduction
Lumbar epidural steroid injection is often used to treat patients with spinal stenosis and herniated intervertebral disc. Transforaminal epidural steroid injection (TFESI) is known for delivering at the exact location of nerve root compression by herniated intervertebral disc causing neuropathy. TFESI are largely categorized according to two differing methods, based on the needle entry: subpedicular approach and retrodiscal approach. We evaluated the difference contrast flow and clinical effectiveness between subpedicular and retrodiscal approach of lumbar transforaminal epidural steroid injection for spinal pain.
Methods and Materials
320 patients scheduled for TFESI were randomized to either the subpedicular (SP group) or the retrodiscal approach group (RD group). After appropriately placing the spinal needle, we analyzed the maximal distribution of contrast flow by injecting contrast medium (0.5, 1, 1.5, 2, 2.5 and 3ml, total 6 times) during TFESI for both group. The contrast patterns were graded into 4 categories (Fig. 1 and 2). Grade 1 was defined target nerve root or/and dorsal epidural only at needle insertion level. Grade 2 was defined ventral epidural space with uptake of target nerve root at needle insertion level. Grade 3 was defined ventral epidural space with uptake to exiting nerve root with coverage of the disc proximal to the targeted intervertebral disc. Grade 4 was defined ventral epidural space with uptake to exiting and traversing nerve root with coverage of the disc at the targeted intervertebral disc and medial to the interpedicular line. Pain relief at 2 and 4weeks after procedure, complication related to procedure were recorded. Also, we collected age, gender, weight, height, diagnosis and MRI findings (grading of central or foraminal spinal stenosis, type of HIVD, compression of spinal nerve root).
Results
Data from 134 patients in the RD group and 146 in the SP group were analyzed (Table 1). There was no difference in the grade of contrast pattern by the change of the contrast volume between the both groups. When contrast with 1.5, 2, and 2.5 ml were injected, RD group showed better spread pattern (Grade 3 and 4) in patients with severe central spinal stenosis (P-value=0.027, 0.03, 0.04). Also, when contrast with 1.5 and 2 ml were injected, RD group showed good spread pattern (Grade 3 and 4) in patients with severe foraminal stenosis. Both groups demonstrated a decrease in pain relief at 2 and 4weeks after procedures, but no significant difference was found between the two groups.
Conclusions
It can be recommended that retrodiscal approach has better contrast spread in patients with severe central and foraminal spinal stenosis.
Lumbar epidural steroid injection is often used to treat patients with spinal stenosis and herniated intervertebral disc. Transforaminal epidural steroid injection (TFESI) is known for delivering at the exact location of nerve root compression by herniated intervertebral disc causing neuropathy. TFESI are largely categorized according to two differing methods, based on the needle entry: subpedicular approach and retrodiscal approach. We evaluated the difference contrast flow and clinical effectiveness between subpedicular and retrodiscal approach of lumbar transforaminal epidural steroid injection for spinal pain.
Methods and Materials
320 patients scheduled for TFESI were randomized to either the subpedicular (SP group) or the retrodiscal approach group (RD group). After appropriately placing the spinal needle, we analyzed the maximal distribution of contrast flow by injecting contrast medium (0.5, 1, 1.5, 2, 2.5 and 3ml, total 6 times) during TFESI for both group. The contrast patterns were graded into 4 categories (Fig. 1 and 2). Grade 1 was defined target nerve root or/and dorsal epidural only at needle insertion level. Grade 2 was defined ventral epidural space with uptake of target nerve root at needle insertion level. Grade 3 was defined ventral epidural space with uptake to exiting nerve root with coverage of the disc proximal to the targeted intervertebral disc. Grade 4 was defined ventral epidural space with uptake to exiting and traversing nerve root with coverage of the disc at the targeted intervertebral disc and medial to the interpedicular line. Pain relief at 2 and 4weeks after procedure, complication related to procedure were recorded. Also, we collected age, gender, weight, height, diagnosis and MRI findings (grading of central or foraminal spinal stenosis, type of HIVD, compression of spinal nerve root).
Results
Data from 134 patients in the RD group and 146 in the SP group were analyzed (Table 1). There was no difference in the grade of contrast pattern by the change of the contrast volume between the both groups. When contrast with 1.5, 2, and 2.5 ml were injected, RD group showed better spread pattern (Grade 3 and 4) in patients with severe central spinal stenosis (P-value=0.027, 0.03, 0.04). Also, when contrast with 1.5 and 2 ml were injected, RD group showed good spread pattern (Grade 3 and 4) in patients with severe foraminal stenosis. Both groups demonstrated a decrease in pain relief at 2 and 4weeks after procedures, but no significant difference was found between the two groups.
Conclusions
It can be recommended that retrodiscal approach has better contrast spread in patients with severe central and foraminal spinal stenosis.
.jpg)
