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Skeletal Radiology

, Volume 41, Issue 12, pp 1613–1618 | Cite as

An evaluation of contrast medium spread on caudal epidurography with the needle positioned toward the affected side in patients with unilateral lumbosacral radiculopathy

  • Jae Hoon Lee
  • Duck Mi Yoon
  • Tae Dong Kwon
  • Kyung Bong YoonEmail author
Technical Report

Abstract

Objective

We used caudal epidurography to compare the spread of contrast medium when the needle was inserted toward the affected side in patients with unilateral radiculopathy undergoing caudal steroid injection.

Materials and methods

We enrolled 24 patients with unilateral radiculopathy. A block needle was positioned toward the affected side in the sacral epidural space. After 5 mL of iodinated contrast medium was injected, a standardized anteroposterior view was imaged. Using Adobe Photoshop software, contrast medium spread was assessed by counting pixels within the areas spread on the affected side and on the opposite side, and the pixel counts of the two sides were compared. Spinal nerve root filling was also assessed.

Results

The pixel count within the area of contrast medium spread on the side with the needle was significantly greater than that of the opposite side (mean [SD] 41,368.6 [13,143.1] vs 15,165.3 (10,698.1), P < 0.001]. However, 13.6% of the study patients had greater spread on the opposite side. The rates of L5 and S1 nerve root filling in the affected side were 18.2% and 36.4% respectively.

Conclusions

When a needle was intentionally inserted toward the side with radiculopathy, the spread of contrast medium and number of delineated roots tended to be greater on the side with the needle, compared with those on the opposite side. However, the pattern of contrast medium spread in the sacral epidural space varied and some patients even had greater spread on the opposite side.

Keywords

Caudal epidural injection Contrast media Radiculopathy 

References

  1. 1.
    Whitlock EL, Bridwell KH, Gilula LA. Influence of needle tip position on injectate spread in 406 interlaminar lumbar epidural steroid injections. Radiology. 2007;243:804–11.PubMedCrossRefGoogle Scholar
  2. 2.
    Weil L, Frauwirth NH, Amirdelfan K, Grant D, Rosenberg JA. Fluoroscopic analysis of lumbar epidural contrast spread after lumbar interlaminar injection. Arch Phys Med Rehabil. 2008;89:413–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Prusinkiewicz C, Lang S, Tsui BCH. Lateral cervical epidural catheter placement using nerve stimulation for continuous unilateral upper extremity analgesia following a failed continuous peripheral nerve block. Acta Anaesthesiol Scand. 2005;49:579–82.PubMedCrossRefGoogle Scholar
  4. 4.
    Thomas B, James CC. Lateral cervical epidural catheter placement for continuous unilateral extremity analgesia and sympathetic block. Reg Anesth Pain Med. 2000;25:313.Google Scholar
  5. 5.
    Dauri M, Sidiropoulou T, Fabbi E, Mariani PP, Sabato AF. Intentional lateral epidural catheter placement for anterior cruciate ligament reconstruction. Acta Anaesthesiol Scand. 2005;49:671–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Borghi B, Agnoletti V, Ricci A, van Oven H, Montone N, Casati A, Editor S. A prospective, randomized evaluation of the effects of epidural needle rotation on the distribution of epidural block. Anesth Analg. 2004;98:1473–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Racz GB, Noe CE. Pelvic spinal neuroaxial procedures. In: Raj PP, editor. Interventional pain management: image-guided procedures. 2nd ed. Philadelphia: Saunders Elsevier; 2008. p. 405–8.Google Scholar
  8. 8.
    Carette S, Leclaire R, Marcoux S, et al. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med. 1997;335:1634–40.CrossRefGoogle Scholar
  9. 9.
    Manchikanti L, Cash KA, Pampati V, McManus CD, Damron KS. Evaluation of fluoroscopically guided caudal epidural injections. Pain Physician. 2004;7:81–92.PubMedGoogle Scholar
  10. 10.
    Manchikanti L, Bakhit C, Pampati V. The role of epidurography in caudal neuroplasty. Pain Digest. 1998;8:277–81.Google Scholar
  11. 11.
    Kim KM, Kim HS, Choi KH, Ahn WS. Cephalic spreading levels after volumetric caudal epidural injections in chronic low back pain. J Korean Med Sci. 2001;16:193–7.PubMedGoogle Scholar
  12. 12.
    Grundy EM, Ramamurthy S, Patel KP, Mani M, Winnie AP. Extradural analgesia revisited. A statistical study. Br J Anaesth. 1978;50:805–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Asato F, Goto F. Radiographic findings of unilateral epidural block. Anesth Analg. 1996;83:519–22.PubMedGoogle Scholar
  14. 14.
    Luyendijk W. The plica mediana dorsalis of the dura mater and its relation to lumbar peridurography (canalography). Neuroradiology. 1976;11:147–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Abdi S, Datta S, Trescot AM, et al. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician. 2007;10:185–212.PubMedGoogle Scholar
  16. 16.
    Conn A, Buenaventura RM, Datta S, Abdi S, Diwan S. Systematic review of caudal epidural injections in the management of chronic low back pain. Pain Physician. 2009;12:109–35.PubMedGoogle Scholar
  17. 17.
    Yokoyama M, Hanazaki M, Fujii H, et al. Correlation between the distribution of contrast medium and the extent of blockade during epidural anesthesia. Anesthesiology. 2004;100:1504–10.PubMedCrossRefGoogle Scholar
  18. 18.
    Marret E, Gibert S, Bonnet F. Can epidurography help to predict the extent of epidural blockade? Anesthesiology. 2005;102:478. author reply 479.PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2012

Authors and Affiliations

  • Jae Hoon Lee
    • 1
  • Duck Mi Yoon
    • 1
  • Tae Dong Kwon
    • 1
  • Kyung Bong Yoon
    • 1
    Email author
  1. 1.Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research InstituteYonsei University College of MedicineSeoulSouth Korea

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