Analysis of Intravascular Flow Patterns following Cervical Transforaminal Epidural Injection
The Korean Journal of Pain
;
: 52-57, 2009.
Article
in Korean
| WPRIM
| ID: wpr-116198
ABSTRACT
BACKGROUND:
Transforaminal epidural injection (TEI) may be useful to treat unilateral pain that has a dermatomal distribution. In this approach, the needle tip can be placed closer to the dorsal root ganglion and ventral aspect of the nerve root. However many studies have reported that serious complications following TEI occurred more frequently when it was conducted at the cervical level. One of the presumptive mechanisms of the complication is intravascular injection. Therefore this study was conducted to identify the incidence of complications in response to intravascular injections at cervical segments.METHODS:
This study included all patients, who visited our pain clinic and had radicular symptoms or herpes zoster associated pain. All procedures were conducted under fluoroscopic guidance with contrast enhancement by one of the authors. After the ideal needle position was confirmed by biplanar fluoroscopy, the blood aspiration through the needle hub was evaluated, and a 3 ml mixture of nonionic contrast (2 ml) with normal saline (1 ml) was injected at a rate of 0.3-0.5 ml/sec continuously under real time fluoroscopic visualization. We then classified the contrast spreading pattern as neural, simultaneous neural and vascular, or vascular.RESULTS:
A total 71 cervical TEIs were performed. In 26 cases (36.6%), the contrast only spread to the nerve sheath. However, 45 cases (63.4%) showed an intravascular spreading pattern, 37 (52.1%) of which showed a neural and vascular pattern and 8 (11.3%) of which showed only a vascular pattern.CONCLUSIONS:
Approximately two thirds of the cases of cervical TEI were found to lead to intravascular spreading, which is much higher than the incidence reported in previous studies.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Injections, Epidural
/
Fluoroscopy
/
Incidence
/
Pain Clinics
/
Ganglia, Spinal
/
Herpes Zoster
/
Needles
Type of study:
Practice guideline
/
Incidence study
/
Prognostic study
Limits:
Humans
Language:
Korean
Journal:
The Korean Journal of Pain
Year:
2009
Type:
Article
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