Differential Rates of Inadvertent Intravascular Injection during Lumbar Transforaminal Epidural Injections Using Blunt-Tip, Pencil-Point, and Catheter-Extension Needles.

OBJECTIVE: To quantify the incidence of inadvertent vascular penetration during lumbosacral transforaminal epidural injections using blunt-tip, pencil-point, and catheter-extension needles. STUDY DESIGN/SETTING: This is a prospective, observational, consecutive cohort study. SUBJECTS: Two hundred consecutive patients undergoing lumbosacral transforaminal epidural injections at an academic outpatient spine center. METHODS: Four hundred seventy-five fluoroscopically guided lumbosacral transforaminal epidural injections were performed on consecutively consenting patients by one interventional spine physician, using three different needle types. The presence or absence of vascular uptake was determined during contrast injection under live fluoroscopy. RESULTS: Vascular uptake of contrast was observed in 58 of the total 475 injections, for an overall incidence of 12.2%. By needle type, the incidence of inadvertent vascular uptake was 16.6% (26/157) in the pencil-point group, 15.6% (24/154) in the blunt-tip group, and 4.9% (8/164) in the catheter-extension group. The difference in rates is statistically significant between the catheter-extension needle group and both the pencil-point group (P = 0.0009) and blunt-tip group (P = 0.0024). A secondary analysis was performed to quantify the incidence of functional pitfalls between needle groups, with a significantly lower incidence in the pencil-point group compared to both the catheter-extension (P = 0.0148) and blunt-tip needle (P = 0.0288) groups. CONCLUSIONS: Blunt-tip and pencil-point needles have comparable risk of inadvertent vascular injection during lumbosacral transforaminal injections. Catheter-extension needles demonstrated a reduce incidence of vascular uptake, but also result in a significantly higher rate of functional pitfalls that limits their usefulness in routine practice.

Return to play considerations for cervical spine injuries in athletes.

Injuries to the cervical spine during sports are relatively common, depending on the specific sport. Given the adjacent neurovascular structures, any injury to the cervical spine must be evaluated with caution to assess its severity. With proper management, most injuries resolve quickly and allow for rapid return to play (RTP). The purpose of this article is to synthesize the current literature on the most common cervical spine injuries in athletes, including injury prevalence, mechanisms of injury, and RTP decision-making processes.