Contrast spread in the superoposterior approach of transforaminal epidural steroid injections for lumbosacral radiculopathy

Young Cheol Jeong, Chung Ho Lee, Seok Kang, Joon Shik Yoon

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1 Citation (Scopus)

Abstract

Objective To observe the contrast spread in superoposterior transforaminal epidural steroid injection (SP TFESI) and investigate the correlation between spread patterns and efficacy. Methods Thirty-one patients with lumbosacral radiculopathy underwent single-level TFESI under fluoroscopy. The final needle tip position was targeted toward the SP quadrant of the intervertebral foramen. To observe the spread, 1 mL of contrast material was injected, followed by a steroid injection. The contrast spread was graded anteroposteriorly and vertically in the epidural space. The effect of SP TFESI was evaluated by proportional pain score reduction. Results Levels injected were L4-5 (n=20) and L5-S1 (n=11). Seventeen cases were lateral, and 14 were central herniated disc (HD). Baseline mean visual analog scale score was 6.23. Contrast dispersed dorsally in all the cases, and 45.2% cases showed a concurrent ventral spread. The proportion of the pain reduction after 2 weeks showed no difference between the two groups. In vertical spreading analysis, mean cephalic/caudal grades were 1.40/1.55 at L4-5 level and 1.73/1.64 at L5-S1 level. The HD location had no effect on contrast dispersion. Conclusion In SP TFESI, ventral contrast spread did not guarantee a better effect; however, the extent of cephalic flow in ventral expansion group correlated with the proportion of pain reduction.

Original languageEnglish
Pages (from-to)413-420
Number of pages8
JournalAnnals of Rehabilitation Medicine
Volume41
Issue number3
DOIs
Publication statusPublished - 2017 Jun 1

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Keywords

  • Contrast media
  • Epidural injection
  • Lumbosacral
  • Radiculopathy
  • Treatment outcome

ASJC Scopus subject areas

  • Rehabilitation

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