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CT-Fluoroscopic Cervical Transforaminal Epidural Steroid Injections: Extraforaminal Needle Tip Position Decreases Risk of Intravascular Injection

CT-Fluoroscopic Cervical Transforaminal Epidural Steroid Injections: Extraforaminal Needle Tip... BACKGROUND AND PURPOSE: Cervical transforaminal epidural steroid injections are commonly performed for temporary pain relief or diagnostic presurgical planning in patients with cervical radiculopathy. Intravascular injection of steroids during the procedure can potentially result in cord infarct, stroke, and even death. CT-fluoroscopy allows excellent anatomic resolution and precise needle positioning. This study sought to determine the safest needle tip position during CT-guided cervical transforaminal epidural steroid injection as determined by the incidence of intravascular injection. MATERIALS AND METHODS: We retrospectively evaluated procedural imaging for consecutive single-site CT-fluoroscopic cervical transforaminal epidural steroid injection performed during a 13-month period. Intravascular injections were identified and classified by volume, procedure phase, vessel type, and needle tip position relative to the targeted neural foramen. ANOVA, Wilcoxon, or Pearson χ 2 testing was used to assess differences among groups as appropriate. RESULTS: Intravascular injections occurred in 49/201 (24%) procedures. Of the intravascular injections, 13/49 (27%) were large, 10/49 (20%) were small, and 26/49 (53%) were trace volume. Sixteen of 49 (33%) intravascular injections occurred with a trial contrast dose; 27/49 (55%), with a steroid/analgesic cocktail; and 6/49 (12%), with both. Twenty-seven of 49 (55%) intravascular injections were likely venous, 22/49 (45%) were indeterminate, and none were likely arterial. The intravascular injection rate was significantly lower ( P < .001) for the extraforaminal needle position (8/82, 10%) compared with junctional (27/88, 31%) and foraminal (14/31, 45%) needle tip positions. CONCLUSIONS: An extraforaminal needle position for CT-guided cervical transforaminal epidural steroid injection decreases the risk of intravascular injection and therefore may be safer than other needle tip positions. ABBREVIATION: TFESI transforaminal epidural steroid injection http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

CT-Fluoroscopic Cervical Transforaminal Epidural Steroid Injections: Extraforaminal Needle Tip Position Decreases Risk of Intravascular Injection

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References (27)

Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2016 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A4603
pmid
26611993
Publisher site
See Article on Publisher Site

Abstract

BACKGROUND AND PURPOSE: Cervical transforaminal epidural steroid injections are commonly performed for temporary pain relief or diagnostic presurgical planning in patients with cervical radiculopathy. Intravascular injection of steroids during the procedure can potentially result in cord infarct, stroke, and even death. CT-fluoroscopy allows excellent anatomic resolution and precise needle positioning. This study sought to determine the safest needle tip position during CT-guided cervical transforaminal epidural steroid injection as determined by the incidence of intravascular injection. MATERIALS AND METHODS: We retrospectively evaluated procedural imaging for consecutive single-site CT-fluoroscopic cervical transforaminal epidural steroid injection performed during a 13-month period. Intravascular injections were identified and classified by volume, procedure phase, vessel type, and needle tip position relative to the targeted neural foramen. ANOVA, Wilcoxon, or Pearson χ 2 testing was used to assess differences among groups as appropriate. RESULTS: Intravascular injections occurred in 49/201 (24%) procedures. Of the intravascular injections, 13/49 (27%) were large, 10/49 (20%) were small, and 26/49 (53%) were trace volume. Sixteen of 49 (33%) intravascular injections occurred with a trial contrast dose; 27/49 (55%), with a steroid/analgesic cocktail; and 6/49 (12%), with both. Twenty-seven of 49 (55%) intravascular injections were likely venous, 22/49 (45%) were indeterminate, and none were likely arterial. The intravascular injection rate was significantly lower ( P < .001) for the extraforaminal needle position (8/82, 10%) compared with junctional (27/88, 31%) and foraminal (14/31, 45%) needle tip positions. CONCLUSIONS: An extraforaminal needle position for CT-guided cervical transforaminal epidural steroid injection decreases the risk of intravascular injection and therefore may be safer than other needle tip positions. ABBREVIATION: TFESI transforaminal epidural steroid injection

Journal

American Journal of Neuroradiology – American Journal of Neuroradiology

Published: Apr 1, 2016

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