Technical efficacy and safety of CT-guided transforaminal periradicular infiltration using CT foot switches and MPR images
Main Article Content
CT-guided transforaminal periradicular infiltration; efficacy and safety; CT foot switches; MPR images.
To demonstrate the technical efficacy and safety of CT-guided transforaminal periradicular infiltration in the treatment of the radicular pain without surgical intervention, using CT foot switches and MPR images.
MATERIALS AND METHODS:
Four hundred and eighty two patients (286 males and 196 females, age range 27-71 years, mean age 56 years) with a unilateral or bilateral radiculopathy who underwent CT-guided transforaminal periradicular infiltration without surgical intervention, were retrospectively selected in the period from January 2019 to February 2020. Patients who had received surgery for herniated disc or laminectomy, patients with a previous vertebral fractures, and patients with inflammatory syndrome or risk of bleeding were excluded.
There were no major or minor clinically relevant complications. Many patients a marked reduction or resolution of pain after the CT-guided infiltration (P<0.05). No patient required hospitalization. One patient reported an episode of intense headache, which resolved after twenty minutes.
In eleven cases, a slight increase in pain related to spinal compression caused by the administration of the drug was reported, even if administrated extremely slowly.
Sixteen patients reported pain in the upper limbs during and after the procedure, however this was not related to infiltration but to the forced and prolonged arm position.
CT-guided transforaminal periradicular infiltration is a semi-invasive and well tolerated procedure, moreover it has a reduced comorbidity and no observed major or minor complications.
The CT foot switches and MPR evaluation may help to make the procedure more efficient.
2. Cluff R, Mehio AK, Cohen SP, Chang Y, Sang CN, Stojanovic MP. The technical aspects of epidural steroid injections: a national survey. Anesth Analg 2003;95:403-408.
3. Ali Harman, Enes Duman, Adnan Ozdemir. The effectiveness of computed tomography-guided lumbar epidural steroid injections for spinal pain management: A single center experience with 2year follow-up. Biomedical Research 2017;28(18):7775-7778.
4. Depriester C, Setbon S, Larde A, et al. CT-guided transforaminal cervical and lumbar epidural infiltrations. Diagn Interv Imaging. 2012;93(9):704-710.
5. Houten JK Errico TJ. Paraplegia after lumbosacral nerve root block: Report of three cases. Spine J 2002;2:70-75.
6. Huntoon M Martin D. Paralysis after transforaminal epidural injection and previous spinal surgery. Reg Anesth Pain Med 2004;29:494-495.
7. Somyaji HS Saifuddin A Casey ATH Briggs TWR. Spinal cord infarction following therapeutic compute tomography-guided left L2 nerve root injection. Spine 2005;30:E106-108.
8. Kennedy DJ Dreyfuss P Aprill CN Bogduk N. Paraplegia following image-guided transforaminal lumbar spine epidural steroid injection: Two case reports. Pain Med 2009;19:1389-1394.
9. Atluri S, Glaser SE, Shah R, et al. Needle position analysis in cases of paralysis from transforaminal epidurals: consider alternative approaches to traditional technique. Pain Physician. 2013;16(4):321-334.
10. Brouwers PJ, Kottink EJ, Simon MA, Prevo RL. A cervical anterior spinal artery syndrome after diagnostic blockade of the right C6-nerve root. Pain. apr 2001;91(3):397‑9.
11. Chang Chien GC, Candido KD, Knezevic NN. Digital subtraction angiography does not reliably prevent paraplegia associated with lumbar transforaminal epidural steroid injection. Pain Physician. dec 2012;15(6):51-523.
12. Glaser SE, Falco F. Paraplegia following a thoracolumbar transforaminal epidural steroid injection. Pain Physician. jul 2005;8(3):309‑14.
13. Tiso RL, Cutler T, Catania JA, Whalen K. Adverse central nervous system sequelae after selective transforaminal block: the role of corticosteroids. Spine J Off J North Am Spine Soc. Aug 2004;4(4):468‑74.
14. Bose B. Quadriparesis following cervical epidural steroid injections: case report and review of the literature. Spine J Off J North Am Spine Soc. oct 2005;5(5):558‑63.
15. Hodges SD, Castleberg RL, Miller T, Ward R, Thornburg C. Cervical epidural steroid injection with intrinsic spinal cord damage. Two case reports. Spine. 1 oct 1998;23(19):2137‑2142.
16. Houten JK, Errico TJ. Paraplegia after lumbosacral nerve root block: report of three cases. Spine J Off J North Am Spine Soc. feb 2002;2(1):70‑7.
17. Kennedy DJ, Dreyfuss P, Aprill CN, Bogduk N. Paraplegia following image-guided transforaminal lumbar spine epidural steroid injection: two case reports. Pain Med Malden Mass. nov 2009;10(8):1389‑1394.
17. Windsor RE, Storm S, Sugar R. Prevention and management of complications resulting from common spinal injections. Pain Physician. oct 2003;6(4):473-483.
19. Diehn FE, Murthy NS, Maus TP. Science to Practice: What Causes Arterial Infarction in Transforaminal Epidural Steroid Injections, and Which Steroid Is Safest? Radiology. jui 2016;279(3):657‑659.
20. Benzon HT, Chew T-L, McCarthy RJ, Benzon HA, Walega DR. Comparison of the particle sizes of different steroids and the effect of dilution: a review of the relative neurotoxicities of the steroids. Anesthesiology. feb 2007;106(2):331‑338.
21. Derby R, Lee S-H, Date ES, Lee J-H, Lee C-H. Size and aggregation of corticosteroids used for epidural injections. Pain Med Malden Mass. mars 2008;9(2):227‑234.
22. Laemmel E, Segal N, Mirshahi M, Azzazene D, Le Marchand S, Wybier M, et al. Deleterious Effects of Intra-arterial Administration of Particulate Steroids on Microvascular Perfusion in a Mouse Model. Radiology. jun 2016;279(3):731‑740.
23. Laredo J-D, Laemmel E, Vicaut E. Serious neurological events complicating epidural injections of glucocorticoid suspensions: evidence for a direct effect of some particulate steroids on red blood cells. RMD Open. 2016;2(2):e000320.