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Ab s t r Ac t Objective: To see effectiveness of measurements in plain roentgenograms of lumbosacral (LS) spine to guide needle placement into the epidural space. Setting: Department of Physical Medicine and Rehabilitation. Design: Cross-sectional study. Materials and methods: A total of 56 consecutive diagnosed prolapsed intervertebral disk (PIVD) patients attending PMR OPD were enrolled. Length of the spinous process and skin thickness were measured using a caliper, which were converted to centimeter by using a calibration bar in a digital X-ray of the LS spine. A 22G Quincke needle was advanced to the expected depth given by digital X-ray measurement. One milliliter of Iohexol dye was injected, and the position of the needle was checked by C-arm X-ray. Two milliliters of methyl prednisolone acetate were injected into the space. Main outcome measures: Depth measured by using digital X-ray and length of the spinal needle from the epidural space to the skin by C-arm X-ray in centimeters. Results: Out of 56 subjects, 46 (73.1%) completed the treatment program. A needle was placed at proper depth in 36 cases by using X-ray measurement, giving success rate of 87.8%. Depth of the epidural space from the skin (mean 3.82 ±0.74 cm) as measured from X-ray and actual measurement confirmed by fluoroscopy (mean 3.96 ± 0.81 cm) were compared using the Pearson’s correlation coefficient (=0.86). Conclusion: Measurement of depth of the epidural space using plain X-ray of the LS spine improves the success rate of blind midline interlaminar epidural steroid injection (MILESI) from around 50–87.8%. This method of nonreal-time imaging is cost-effective in developing countries where C-arm X-ray facilities are not available.

indian journal of physical medicine and rehabilitation/indian journal of physical medicine and rehabilitation

Role of Nonreal-time Imaging in Improving Success of Blind Interlaminar Epidural Injection for Treatment of Symptomatic Prolapsed Lumbar Intervertebral Disk