Skip to main content
SpringerLink
Log in

Incidence of inadvertent intra-articular lumbar facet joint injection during fluoroscopically guided interlaminar epidural steroid injection

Skeletal Radiology Aims and scope Submit manuscript

Cite this article

Abstract

Objective

To determine the incidence of inadvertent lumbar facet joint injection during an interlaminar epidural steroid injection (ESI).

Materials and methods

A total of 686 interlaminar lumbar ESIs were performed from January 1, 2009 to December 31, 2009. Archived images from these cases were retrospectively reviewed on the PACS. Positive cases of inadvertent lumbar facet joint injection were identified by the characteristic sigmoid-shaped contrast pattern projecting over the posterior elements on the lateral view and/or ovoid contrast projecting over the facet joints on the anteroposterior (AP) view.

Results

Eight positive events were identified (1.2%). There was no statistically significant gender or lumbar level predilection. In 3/8 of the positive cases (37.5%), the inadvertent facet joint injection was recognized by the operator. The needle was repositioned as a result, and contrast within the posterior epidural space was documented by the end of the procedure. In 5/8 of the positive cases (62.5%), the patients reported an immediate decrease in the presenting pain.

Conclusions

The incidence of inadvertent lumbar facet joint injection during an interlaminar epidural steroid injection is low. Recognizing the imaging features of this event permits the operator to redirect the needle tip into the epidural space and/or identify the facet joint(s) as a source of the patient’s presenting pain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Hashemi L, Webster BS, Clancy EA. Trends in disability duration and cost of workers’ compensation low back pain claims (1988–1996). J Occup Environ Med. 1998;40:1110–9.

    PubMed  CAS  Google Scholar 

  2. Guo HR, Tanaka S, Halperin WE, Cameron LL. Back pain prevalence in US industry and estimates of lost workdays. Am J Public Health. 1999;89:1029–35.

    Article  PubMed  CAS  Google Scholar 

  3. Eley C. Magnetic resonance imaging for low back injuries: appropriate use in managing workers’ compensation claims. AAOHN J. 2006;54:429–33.

    PubMed  Google Scholar 

  4. Turner JA, Franklin G, Fulton-Kehoe D, et al. Worker recovery expectations and fear-avoidance predict work disability in a population-based workers’ compensation back pain sample. Spine. 2006;31:682–9.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. Huang AJ, Rosenthal DI, Palmer WE. Inadvertent intra-articular lumbar facet joint injection during fluoroscopically guided interlaminar epidural steroid injection. Skeletal Radiol. 2011;40:33–45.

    Article  PubMed  Google Scholar 

  7. Xu GL, Haughton VM, Carrera GF. Lumbar facet joint capsule: appearance at MR imaging and CT. Radiology. 1990;177:415–20.

    PubMed  CAS  Google Scholar 

  8. Okada K. Studies on the cervical facet joints using arthrography of the cervical facet joint (author’s transl). Nippon Seikeigeka Gakkai Zasshi. 1981;55:563–80.

    PubMed  CAS  Google Scholar 

  9. Sarazin L, Chevrot A, Pessis E, et al. Lumbar facet joint arthrography with the posterior approach. Radiographics. 1999;19:93–104.

    PubMed  CAS  Google Scholar 

  10. McCormick CC, Taylor JR, Twomey LT. Facet joint arthrography in lumbar spondylolysis: anatomic basis for spread of contrast medium. Radiology. 1989;171:193–6.

    PubMed  CAS  Google Scholar 

  11. Maldague B, Mathurin P, Malghem J. Facet joint arthrography in lumbar spondylolysis. Radiology. 1981;140:29–36.

    PubMed  CAS  Google Scholar 

  12. Chen CK, Yeh L, Resnick D, et al. Intraspinal posterior epidural cysts associated with Baastrup’s disease: report of 10 patients. AJR Am J Roentgenol. 2004;182:191–4.

    PubMed  Google Scholar 

  13. Candido KD, Raghavendra MS, Chinthagada M, Badiee S, Trepashko DW. A prospective evaluation of iodinated contrast flow patterns with fluoroscopically guided lumbar epidural steroid injections: the lateral parasagittal interlaminar epidural approach versus the transforaminal epidural approach. Anesth Analg. 2008;106:638–44.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. Link SC, el-Khoury GY, Guilford WB. Percutaneous epidural and nerve root block and percutaneous lumbar sympatholysis. Radiol Clin North Am. 1998;36:509–21.

    Article  PubMed  CAS  Google Scholar 

  16. Huang J, Kwa A. Lumbar discogram resulting from lumbar interlaminar epidural injection. J Clin Anesth. 2004;16:296–8.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors have no conflict of interest.

Author information

Authors and Affiliations

  1. Massachusetts General Hospital, Department of Radiology, Division of Musculoskeletal Imaging & Intervention, 55 Fruit Street, Yawkey 6E, Boston, MA, 02114, USA

    Ambrose J. Huang & William E. Palmer

Authors
  1. Ambrose J. Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William E. Palmer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ambrose J. Huang.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Huang, A.J., Palmer, W.E. Incidence of inadvertent intra-articular lumbar facet joint injection during fluoroscopically guided interlaminar epidural steroid injection. Skeletal Radiol 41, 157–162 (2012). https://doi.org/10.1007/s00256-011-1332-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-011-1332-y

Keywords

search

Navigation