To observe the contrast spreading patterns in the retrodiscal (RD) approach for transforaminal epidural steroid injections and their effect on pain reduction.
Patients with L5 radiculopathy who were scheduled to receive lumbar TF-EPB were consecutively included. We randomly divided them into the L4-5 RD and L5-S1 RD groups and administered 1 cc of contrast dye into epidural space. We observed the shape and the location of contrast dye on the anterior-posterior and lateral views. We injected 1 cc of 0.5% lidocaine mixed with 20 mg of triamcinolone, and checked the pain intensity before and two weeks after the procedure by using visual analogue scale (VAS).
In the L4-5 RD group (n=30), contrast spread over the L4 nerve root in 27 cases and the L4 and L5 nerve roots in 3 cases. In the L5-S1 RD group (n=33), contrast spread over the L5 nerve root in 20 cases, the S1 nerve root in 3 cases, and the L5 and the S1 nerve roots in 10 cases. The contrast spreading patterns could be divided into 4 patterns: the proximal root in 40 cases, the distal root in 19 cases, the anterior epidural space in 3 cases and an undefined pattern in 1 case.
In RD lumbar TF-EPB, the contrast dye mostly went into the cephalic root and about 60% spread over the proximal nerve root. There was less pain reduction when the contrast dye spread over the distal nerve root.
Citations
Effect of Needle Tip Position on Contrast Media Dispersion Pattern in Transforaminal Epidural Injection Using Kambin’s Triangle Approach
Method: Epidural block with blind approach has been done for the patients who suffered from lower back pain with radiating pain due to spinal disorders. Conventional blind approaches using the glass syringe (control group) and the newly invented instrument (experimental group) were applied to each 30 patients, respectively. Epidurography was used for the confirmation to conclude success or not.
Results: Two cases were failed in the control group. One case showed injected contrast media in the interspinal ligament, another case revealed dura-puncture. But there was no failure in the experimental group. The mean time from skin-penetration to epidurography was 299.7⁑13.6 second in control group and 184.0⁑16.3 second in experimental group. The mean time from changing to glass syringe (control group) or epidural detector (experimental group) to epidurography was 146.0⁑14.0 second in control group and 60.0⁑7.0 second in experimental group. The time for epidural block was much less in experimental group (p＜ 0.001).
Conclusion: This newly invented epidural detector could make the epidural block easier, safer, and faster. We suggest this instrument is useful complementary method for spinal epidural procedure. (J Korean Acad Rehab Med 2003; 27: 968-973)
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