Open Access(219) Epiduralgrams: Characteristics of Contrast Flow Within the Epidural Space
Author(s) -
Miller David C.
Publication year - 2001
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/j.1526-4637.2001.pme01039-19.x
Subject(s) - medicine , epidural space , epidural steroid injection , local anesthetic , contrast (vision) , lumbar , anesthesia , subarachnoid space , sciatica , radicular pain , surgery , low back pain , cerebrospinal fluid , alternative medicine , pathology , artificial intelligence , computer science
Fluoroscopically guided, contrast enhanced epidural steroid injections are commonly performed for persistent or severe lumbar radicular pain. An epiduralgram is a real‐time fluoroscopic image of contrast injected into the epidural space executed prior to the injection of local anesthetic and steroid. Epiduralgrams are performed in order to enhance the accuracy of delivering medication to the target site and to avoid inadvertent intravascular or subarachnoid injection. This study retrospectively examines the characteristics of fifty consecutive epiduralgrams. All patients had sciatica for at least six weeks duration and had failed conventional conservative care. Epiduralgrams confirmed that needles were placed at the preoperatively chosen spinal level 100% of the time. Needles were placed lateral to the midline at the preoperatively chosen side 100% of the time. A contrast volume of 3 ml flowed unilaterally in 76% of injections. Contrast flowed cephalad and caudad from the needle in 52%, caudad only in 28%, and cephalad only in 20%. Subsequent local anesthetic and steroid injection dispersed the contrast 100% of the time and remained unilateral on the desired side in 68% of injections. Contrast volume of 3 ml spread over two spinal levels in 64%, and 7 ml of mixed local anesthetic and steroid dispersed the contrast over a mean of 2.7 spinal levels. The desired nerve root was visualized in 62% of post injection epiduralgrams. Epiduralgrams provide the spinal injectionist with essential information. The characteristics of fluid movement within the epidural space need further clarification.