The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Effect of epidural corticosteroid injection on magnetic resonance imaging findings

  • Kim, Min Soo (Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine) ;
  • Jeong, Tae Yoon (Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine) ;
  • Cheong, Yu Seon (Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine) ;
  • Jeon, Young Wook (Department of Radiology, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine) ;
  • Lim, So Young (Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Hallym University Hospital, School of Medicine) ;
  • Kang, Seong Sik (Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine) ;
  • Kim, In Nam (Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine) ;
  • Chang, Tsong Bin (Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine) ;
  • Seong, Hyun Ho (Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine) ;
  • Hwang, Byeong Mun (Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine)
  • Received : 2017.08.02
  • Accepted : 2017.09.19
  • Published : 2017.10.01
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Abstract

Background: Magnetic resonance imaging (MRI) of the spine is the preferred diagnostic tool for pathologic conditions affecting the spine. However, in patients receiving epidural corticosteroid injection (ESI) for treatment of spinal diseases, there is a possibility of misreading of MR images because of air or fluid in the epidural space after the injection. Therefore, we defined the characteristics of abnormal changes in MRI findings following an ESI in patients with low back pain. Methods: We reviewed the medical records of 133 patients who underwent MRI of the lumbar spine within 7 days after ESI between 2006 and 2015. All patients were administered an ESI using a 22-gauge Tuohy needle at the lumbar spine through the interlaminar approach. The epidural space was identified by the loss of resistance technique with air. Results: The incidences of abnormal changes in MRI findings because of ESI were 54%, 31%, and 25% in patients who underwent MRI at approximately 24 h, and 2 and 3 days after ESI, respectively. Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes. Epidural air, the most frequent abnormal finding (82%), was observed in 41% of patients who underwent MRI within 3 days after injection. Abnormal findings due to an ESI were not observed in MR images acquired 4 days after ESI or later. Conclusions: Pain physicians should consider the possibility of abnormal findings in MR images acquired after epidural injection using the interlaminar approach and the loss of resistance technique with air at the lumbar spine.

Keywords

References

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