scholarly journals Evaluation of Lumbar Transforaminal Epidural Injections With Needle Placement and Contrast Flow Patterns: A Prospective, Descriptive Report

2004 ◽  
Vol 2;7 (4;2) ◽  
pp. 217-223
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Flow Patterns ◽  
Needle Placement ◽  
Epidural Injections ◽  
Contrast Flow

scholarly journals Incidence of Extravascular Perivertebral Artery Contrast Flow During Cervical Transforaminal Epidural Injections

Pain Medicine ◽  
2020 ◽  
Vol 21 (9) ◽  
pp. 1753-1758
Author(s):  
Joshua Levin ◽  
Manoj Mohan ◽  
David Levi ◽  
Scott Horn ◽  
Matthew Smuck
Keyword(s):  
Vertebral Artery ◽  
Flow Pattern ◽  
Epidural Injection ◽  
Flow Patterns ◽  
Rater Reliability ◽  
Epidural Injections ◽  
Kappa Value ◽  
Transforaminal Epidural Injection ◽  
Contrast Flow

Abstract Background During a cervical transforaminal epidural injection, injectate flows along the path of least resistance. Given the proximity of the vertebral artery to the intervertebral foramen, injected contrast may flow along the external wall of the artery. The incidence of this contrast flow pattern during cervical transforaminal epidural injections is unknown. Purpose To determine the incidence of extravascular perivertebral artery contrast flow patterns during cervical transforaminal epidural injections. Study Design/Setting Retrospective, observational, in vivo study. Patient Sample Patients receiving cervical transforaminal epidural injections at a single outpatient spine clinic. Outcome Measures The presence or absence of extravascular perivertebral artery contrast flow. Methods The saved images from 100 consecutive patients were reviewed by two independent observers and classified with or without extravascular perivertebral artery contrast flow. The incidence was determined and kappa was used to examine inter-rater reliability. All disagreements were reviewed, and the final classification was determined by consensus. Results The inter-rater reliability was moderate, with a kappa value of 0.69. The incidence of extravascular perivertebral artery contrast flow patterns was 49% by consensus. No statistically significant differences in incidence were present when comparing three different final needle tip positions. Conclusions During a cervical transforaminal epidural injection, an extravascular perivertebral artery contrast flow pattern is frequently encountered. This includes flow along the exiting nerve and then around the vertebral artery, as suggested by this study. Although this contrast pattern does not represent an intravascular injection into the vertebral artery, practitioners should remain cautious to exclude intravascular needle placement before injecting medication.

Contrast Flow Patterns Based on Needle Tip Position During Cervical Transforaminal Epidural Injections

PM&R ◽  
2021 ◽  
Author(s):  
Josh Levin ◽  
David Levi ◽  
Nolan Gall ◽  
Scott Horn ◽  
Matthew Smuck
Keyword(s):  
Flow Patterns ◽  
Epidural Injections ◽  
Tip Position ◽  
Contrast Flow

scholarly journals An Alternative Approach to Needle Placement in Cervicothoracic Epidural Injections

2012 ◽  
Vol 25 (3) ◽  
pp. 183 ◽  
Author(s):  
Seung Yong Park ◽  
Jung Gil Leem ◽  
Sung Hwan Jung ◽  
Young Ki Kim ◽  
Won Uk Koh
Keyword(s):  
Needle Placement ◽  
Epidural Injections ◽  
Alternative Approach

Modification of the Cervical Transforaminal Epidural Steroid Injection Technique Based Upon the Anatomic Angle of the Superior Articular Process on MRI

Pain Medicine ◽  
2020 ◽  
Vol 21 (10) ◽  
pp. 2090-2099
Author(s):  
David Levi ◽  
Scott Horn ◽  
Jestine Murphy ◽  
Matt Smuck ◽  
Josh Levin
Keyword(s):  
Steroid Injection ◽  
Flow Patterns ◽  
Conventional Technique ◽  
Conventional Approach ◽  
Epidural Steroid Injection ◽  
Injection Technique ◽  
Articular Process ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid ◽  
Contrast Flow

Abstract Objective A modification of the conventional technique for cervical transforaminal epidural steroid injection (CTFESI) has been developed. This technique may, theoretically, decrease the likelihood of the needle encountering the vertebral artery and spinal nerve. The approach uses angle measurements of the superior articular process ventral surface from the patient’s axial MRI as a guide for fluoroscopic set-up and needle trajectory. This report aims to compare contrast flow patterns of the modified approach with those of the conventional technique. Design Retrospective chart review and prospective blinded analysis of contrast flow patterns. Setting. Outpatient interventional physiatry practice. Methods A retrospective blinded qualitative review of fluoroscopic images was performed to compare contrast flow patterns of CTFESIs performed using the modified approach with those using the conventional technique. A detailed description of the modified approach is provided in this report. Results Ninety-seven CTFESI procedures were used for flow analysis. The modified approach resulted in a statistically significant greater percentage of injections with epidural flow: 69% [95% CI = 57–82%] modified approach vs. 42% [95% CI = 28–56%] conventional approach. The modified technique also showed a statistically significant higher percent of injections categorized as having an ideal flow pattern, that of predominate epidural and/or intraforaminal flow: 65% [95% CI = 52–78%] vs. 27% [95% CI = 14–40%]. Conclusions A modification of the conventional CTFESI technique, developed for the purpose of improved safety, may provide superior contrast flow patterns when compared to the conventional approach.

Needle Placement

2018 ◽  
Author(s):  
Kenneth D. Candido ◽  
Teresa M. Kusper
Keyword(s):  
Pain Management ◽  
Needle Placement ◽  
Short Summary ◽  
Injection Techniques ◽  
Interventional Pain Management ◽  
Management Techniques ◽  
Safety Considerations ◽  
Contrast Flow ◽  
Selection Of ◽  
The Ideal

Interventional pain management techniques are invaluable in the treatment of pain from various etiologies. Routine and advanced interventional pain management needle placement is essential not only to guarantee success with intended pain-relieving procedures, but also to minimize known complications from these same procedures. Knowledge of relevant anatomy is crucial. The focus of this chapter is to provide a brief description of various interventional pain management injection techniques. A short summary of the relevant anatomy, landmarks used for needle placement and important safety considerations is provided along with a selection of digital and radiographic photographs depicting the ideal needle placement and contrast flow at or in the immediate proximity of the targeted structures.

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