Contrast flow patterns based on needle tip position during cervical transforaminal epidural injections.
Journal
PM & R : the journal of injury, function, and rehabilitation
ISSN: 1934-1563
Titre abrégé: PM R
Pays: United States
ID NLM: 101491319
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
revised:
16
03
2021
received:
05
11
2020
accepted:
22
03
2021
pubmed:
28
3
2021
medline:
5
4
2022
entrez:
27
3
2021
Statut:
ppublish
Résumé
Few studies have evaluated the effect of final needle position on contrast flow patterns during the performance of cervical transforaminal epidural steroid injections (TFESIs). To analyze fluoroscopically guided cervical TFESI contrast flow patterns based upon final needle tip position. Retrospective, observational in vivo study. Outpatient private practice physical medicine and rehabilitation spine clinic. One hundred consecutive patients undergoing cervical TFESIs. Cervical TFESIs. Categories of contrast flow patterns including epidural, intraforaminal, "sufficient to inject," and "predominantly epidural and/or intraforaminal," based upon final needle tip position. Two independent observers reviewed images from 100 consecutive patients and classified injectate flow patterns stratified by needle tip position. The interrater reliability for all categories of interest was moderate, with kappa values from 0.61 to 0.76. More medially placed needles (middle third and lateral third of the articular pillars) resulted in higher rates of epidural contrast flow (75%; 95% confidence interval [CI]: 56%-94%; and 60%; 95% CI: 47%-73%) compared to needles placed lateral to the articular pillars (26%; 95% CI: 8%-44%), and higher rates of "predominantly epidural and/or intraforaminal" flow patterns with needles placed in the middle one third (75%; 95% CI: 56%-94%) and lateral one third of the articular pillars (47%; 95% CI: 34%-60%) compared to flow patterns when needles were placed lateral to the articular pillars (17%; 95% CI: 2%-32%). No needles were placed in the medial third of the articular pillars. More medially placed needle tips result in more optimal flow patterns during cervical TFESIs. The importance of this finding is unknown as clinical outcomes were not measured.
Sections du résumé
BACKGROUND
Few studies have evaluated the effect of final needle position on contrast flow patterns during the performance of cervical transforaminal epidural steroid injections (TFESIs).
OBJECTIVE
To analyze fluoroscopically guided cervical TFESI contrast flow patterns based upon final needle tip position.
DESIGN
Retrospective, observational in vivo study.
SETTING
Outpatient private practice physical medicine and rehabilitation spine clinic.
PARTICIPANTS
One hundred consecutive patients undergoing cervical TFESIs.
INTERVENTIONS
Cervical TFESIs.
MAIN OUTCOME MEASURES
Categories of contrast flow patterns including epidural, intraforaminal, "sufficient to inject," and "predominantly epidural and/or intraforaminal," based upon final needle tip position.
RESULTS
Two independent observers reviewed images from 100 consecutive patients and classified injectate flow patterns stratified by needle tip position. The interrater reliability for all categories of interest was moderate, with kappa values from 0.61 to 0.76. More medially placed needles (middle third and lateral third of the articular pillars) resulted in higher rates of epidural contrast flow (75%; 95% confidence interval [CI]: 56%-94%; and 60%; 95% CI: 47%-73%) compared to needles placed lateral to the articular pillars (26%; 95% CI: 8%-44%), and higher rates of "predominantly epidural and/or intraforaminal" flow patterns with needles placed in the middle one third (75%; 95% CI: 56%-94%) and lateral one third of the articular pillars (47%; 95% CI: 34%-60%) compared to flow patterns when needles were placed lateral to the articular pillars (17%; 95% CI: 2%-32%). No needles were placed in the medial third of the articular pillars.
CONCLUSIONS
More medially placed needle tips result in more optimal flow patterns during cervical TFESIs. The importance of this finding is unknown as clinical outcomes were not measured.
Substances chimiques
Steroids
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
377-382Informations de copyright
© 2021 American Academy of Physical Medicine and Rehabilitation.
Références
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