Comparison of Incidences of Intravascular Injection between Medial and Lateral Side Approaches during Traditional S1 Transforaminal Epidural Steroid Injection

Purpose. Intravascular injection rates are higher during traditional S1 transforaminal epidural steroid injection (TFESI) compared with lumbar transforaminal injection. We compared the incidences of intravascular injection between the medial and lateral approaches to the S1 foramen during S1 TFESI. Materials and Methods. A total of 139 patients underwent one or more TFESIs (170 total injections). The patients received S1 TFESI by either medial or lateral side of S1 foramen under fluoroscopic anteroposterior view using digital subtraction method. The intravascular injection rates, epidural spread patterns, and contrast volumes required to reach the superior aspect of the L5-S1 intervertebral disc (SIVD) were compared between groups. Results. Intravascular injection rates during S1 TFESI were significantly lower in the medial approach compared with the lateral approach patients (4.9% versus 38.6%, resp., P<0.001). The medial approach group had more epidural spread to the L5-S1 SIVD than the lateral group (82.1% versus 58.8%, resp.); lower contrast volume amounts were required to extend the L5-S1 SIVD (1.46±0.48 versus 1.90±0.62, resp.). Conclusion. During S1 TFESI, approaching the needle towards the medial part of the S1 foramen may reduce intravascular injection risk.

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A alternative approach for lumbar transforaminal epidural steroid injection—Far lateral approach

Pain Practice ◽

10.1111/papr.13060 ◽

2021 ◽

Author(s):

Jui‐Hsuan Liu ◽

Chengwei Soo ◽

Ying‐Chun Lin ◽

Chia‐Shiang Lin

Keyword(s):

Steroid Injection ◽

Lateral Approach ◽

Epidural Steroid Injection ◽

Alternative Approach ◽

Far Lateral Approach ◽

Transforaminal Epidural Steroid Injection ◽

Far Lateral ◽

Epidural Steroid

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Incidence of intravascular injection and the spread of contrast media during S1 transforaminal epidural steroid injection by two approaches: anteroposterior vs oblique

Anaesthesia ◽

10.1111/anae.13079 ◽

2015 ◽

Vol 70 (8) ◽

pp. 975-984 ◽

Cited By ~ 8

Author(s):

D.-H. Kim ◽

D. M. Yoon ◽

K. B. Yoon

Keyword(s):

Contrast Media ◽

Steroid Injection ◽

Epidural Steroid Injection ◽

Intravascular Injection ◽

Transforaminal Epidural Steroid Injection ◽

Epidural Steroid

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Comparison of Touhy and Quincke needles on intravascular injection rate in lumbar transforaminal epidural block: a randomized prospective trial

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2021-102504 ◽

2021 ◽

pp. rapm-2021-102504

Author(s):

Hyojung Soh ◽

Yujin Jeong ◽

Eung Don Kim

Keyword(s):

Steroid Injection ◽

Prospective Trial ◽

Injection Rate ◽

Epidural Steroid Injection ◽

Tuohy Needle ◽

Spinal Cord Infarction ◽

Procedure Time ◽

Intravascular Injection ◽

Transforaminal Epidural Steroid Injection ◽

Epidural Steroid

BackgroundTransforaminal epidural steroid injection is widely used in clinical practice to effectively deliver injectate into the ventral epidural space. Complications associated with intravascular injection such as spinal cord infarction and paraplegia can occur during transforaminal epidural steroid injection. To improve the safety of the procedure, avoidance of intravascular injection is crucial, for which appropriate needle selection is important. The primary aim of this study was to compare intravascular injection rates during transforaminal epidural steroid injection between commonly used Quincke and Tuohy needles.MethodTwo hundred and four transforaminal epidural steroid injection cases were randomly assigned to one of two needle groups (22-gage Quincke needle or 22-gage Tuohy needle). Intravascular injection was evaluated using digital subtraction angiography. Spread of contrast medium to the ventral and medial epidural spaces was evaluated. Procedure time was compared between the two needle types.ResultsThe overall incidence of intravascular injection was 7.8%. The rate of intravascular injection was significantly lower in the Tuohy needle group than the Quincke needle group (2.9% vs 12.7%, p=0.009). The ventral and medial epidural spread rates of the Tuohy needle group were 92.2% and 95.1%, respectively, significantly higher than those of the Quincke needle group. The procedure time was shorter in the Tuohy needle group than in the Quincke needle group (97.4 (19.3) seconds vs 117.8 (31.9) s; mean difference −20.40 (95% CI −34.35 to −6.45), p=0.005).ConclusionsIn conclusion, Tuohy needles had a lower intravascular injection rate and higher medial and ventral epidural spreading rates than Quincke needles.Trial registration numberKCT0002095.

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