The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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An Analysis of the Contrast Patterns of Lumbar Transforaminal Epidural Injection

요추 경추간공 경막외강 약물주입 시 조영상의 분석

  • Kim, Sae Young (Pain Clinic, CHA General Hospital, College of Medicine, Pochon CHA University) ;
  • Han, Kyung Ream (Department of Anesthesiology and Pain Medicine, Ajou University Hospital, College of Medicine, Ajou University) ;
  • Kim, Chan (Department of Anesthesiology and Pain Medicine, Ajou University Hospital, College of Medicine, Ajou University)
  • 김세영 (포천중문의과대학교 분당차병원 통증클리닉) ;
  • 한경림 (아주대학교 의과대학 아주대학교병원 마취통증의학교실) ;
  • 김찬 (아주대학교 의과대학 아주대학교병원 마취통증의학교실)
  • Received : 2008.11.27
  • Accepted : 2008.12.09
  • Published : 2008.12.30
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Abstract

Background: Lumbar transforaminal epidural injections (LTEIs) have been utilized in the treatment of radicular pain, and LTEIs have the advantage of target-specificity. However, there have not been enough studies on the contrast patterns in LTEIs with using fluoroscopy. The purpose of this study was to evaluate the spreading epidural contrast patterns that are seen during real-time fluoroscopic guided LTEIs. Methods: A total of 131 patients who underwent fluoroscopic guided LTEIs were studied. The inclusion criteria were those patients with low back pain and/or lower extremity pain that was caused by a herniated nucleus pulposus, lumbar spinal stenosis, failed back surgery syndrome, and herpes zoster-associated pain. We classified the contrast patterns in regard to the contrast flow spreading to the nerve root and/or the unilateral, bilateral or cylinderic type of epidural spreading on the AP view of the fluoroscopy and the ventral or dorsal epidural filling on the lateral view. In addition to the pattern analysis, we evaluated the range of contrast spreading from the cranial to the caudal epidural filling and the incidence of an intravascular flow pattern. Results: Epidural spreading was seen in 126 cases (96.2%) of the total patients through the nerve root. Ventral spreading occurred in 120 cases (95.2%). On the AP view, a nerve root with unilateral, bilateral and cylinderic epidural filling was noted for 108 (85.7%), 9 (7.1%) and 9 (7.1%) cases, respectively. The contrast spreading to vertebral segments was smaller for the patients with lumbar spinal stenosis and failed back surgery syndrome than for the other groups (P < 0.0083). The incidence of intravascular injection was 11.1% (14/126). Conclusions: LTEIs using fluoroscopic visualization provided excellent assessment of the ventral epidural filling as well as nerve root filling. However, unilateral epidural spreading was prominent for the LTEIs.

Keywords

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