BACKGROUND:Transforaminal epidural steroid injection (TFESI) is a useful treatment modality for pain management. Most complications of TFESI are minor and transient. However, there is a risk of serious complications such as nerve injury, spinal cord infarct, or paraplegia. Some of the risks are related to direct injury to the vessel or intravascular injection of the particulate steroid. We prospectively tested the hypothesis that the intravascular injection rate of the Whitacre needle is lower than that of the Quincke needle during TFESI. METHODS:This study was a randomized trial of 1376 TFESIs at the S1 level. We collected data of age, gender, height, weight, laterality (right/left), history of lumbosacral spine operation, history of appropriate interval discontinuation of anticoagulation medicines, and underlying disease. During the S1 TFESI, intrasacral bone contact, a blood aspiration test, and real-time fluoroscopy of the intravascular injection using contrast media were investigated. RESULTS:There were no significant differences in the intravascular injection rate with respect to age, gender, height, weight, hypertension, diabetes mellitus, laterality, history of lumbosacral spine operation, or history of appropriate interval discontinuation of anticoagulation medicines. Intravascular injection was significantly associated with a blood aspiration test (P < 0.001), needle tip type (P = 0.002), intrasacral bone contact (P < 0.001), and physicians (some P < 0.05). The use of Quincke needles and intrasacral bone contact increased the rate of intravascular injection. CONCLUSIONS:To reduce the risk of intravascular injection, the use of Whitacre needles without intrasacral bone contact may be a safer and more effective approach.

译文

背景:经椎间孔硬膜外注射类固醇激素(TFESI)是一种有效的疼痛治疗方法。 TFESI的大多数并发症是次要的和短暂的。但是,存在严重并发症的风险,例如神经损伤,脊髓梗塞或截瘫。一些风险与直接伤害血管或类固醇的血管内注射有关。我们前瞻性地检验了在TFESI期间Whitacre针的血管内注射速率比Quincke针的血管内注射速率低的假设。
方法:本研究是在S1级进行的1376个TFESI的随机试验。我们收集了年龄,性别,身高,体重,侧卧度(右/左),腰ac脊柱手术史,适当停用抗凝药物的间隔史以及潜在疾病的数据。在S1 TFESI期间,研究了contrast骨内接触,血液抽吸试验和使用造影剂对血管内注射进行实时荧光检查。
结果:在年龄,性别,身高,体重,高血压,糖尿病,侧卧,腰s部脊柱手术史或适当停用抗凝药物的历史方面,血管内注射率无显着差异。血管内注射与抽血试验(P <0.001),针尖类型(P = 0.002),s骨内接触(P <0.001)和医生(P <0.05)显着相关。使用Quincke针和s骨内接触可增加血管内注射的速度。
结论:为减少血管内注射的风险,使用不带intra骨内接触的Whitacre针可能是一种更安全,更有效的方法。

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