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Epidural interlaminar injections in severe degenerative lumbar spine: fluoroscopy should not be a luxury
  1. Dimitrios K Filippiadis1,
  2. Thomas Rodt2,
  3. Maria-Chrysanthi Kitsou3,
  4. Chrysanthi Batistaki3,
  5. Nikolaos Kelekis1,
  6. Georgia Kostopanagiotou3,
  7. Alexis Kelekis1
  1. 1Second Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital ‘ATTIKON’, Marousi, Athens, Greece
  2. 2Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
  3. 3Second Department of Anaesthesiology, School of Medicine, University of Athens, ‘ATTIKON’ University Hospital, Athens, Greece
  1. Correspondence to Dr Dimitrios K Filippiadis, Second Department of Radiology, University General Hospital "ATTIKON"Medical School, National and Kapodistrian University of Athens, Haidari, Athens 12462, Greece; dfilippiadis{at}yahoo.gr

Abstract

Objective To assess technical efficacy, accuracy, and safety of epidural (interlaminar) injections performed blindly in patients with a severely degenerated lumbar spine.

Methods Over 12 consecutive months, 138 patients with a severe degenerative lumbar spine underwent epidural (interlaminar) injection as therapy for low back pain and neuralgia. Patients had already undergone a blind epidural infiltration with minimum or no pain reduction. The session was repeated in the angiography suite. Patients were placed in the lateral decubitus position. The injection was performed without image guidance by an anaesthesiologist; the target level was defined before the beginning of the procedure. Once air resistance loss was felt it was presumed that the needle was inside the epidural space. Verification of needle position was performed by injection of 1–3 mL of iodinated contrast medium under fluoroscopy in a lateral projection.

Results Correct needle position inside the epidural space was documented in 82/138 cases (59.4%); unexpected extraepidural location was seen in 56/138 cases (40.6%). Target level was reached in 96/138 cases (69.6%); in 42/138 cases (30.4%) the needle was positioned in a non-target level. In 5/138 (3.6%) cases, there was inadvertent intradural position of the needle. Image guidance was subsequently used for correct positioning of the needle, which was feasible in all cases.

Conclusion Blind interlaminar epidural injections lack the accuracy of exact needle location that imaging guidance offers in approximately 40% of cases, when there is difficult spine anatomy and the initial epidural approach has failed to provide pain relief. Image guidance for interlaminar epidural injection ensures accurate needle placement, enhancing the safety and efficacy of the procedure.

  • technique
  • spine
  • intervention
  • epidural
  • benign

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Footnotes

  • The abstract has previously appeared in a conference preceding publication under the title ‘Interlaminar epidural infiltrations in patients with severe degenerative lumbar spine: how often is the needle properly placed in the epidural space without imaging guidance’.

  • Contributors DKF: acquisition, analysis, or interpretation of the data for the work; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. TR: acquisition, analysis, or interpretation of the data for the work. M-CK: substantial contributions to the conception or design of the work. CB: substantial contributions to the conception or design of the work. NK: drafting the work or revising it critically for important intellectual content. GK: drafting the work or revising it critically for important intellectual content. AK: final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Ethics approval The study was approved by the institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Not applicable.

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