Intravascular escape during lumbar transforaminal anterior epidural steroid injection: A retrospective study
Sinem Sarı1
, Saliha Yeter Amasyalı2, Mehmet Emre Yılmaz3, Yasemin Turan4, Ali Yılmaz5, Ali Akyol6, Ömer Faruk Kutsi Köseoğlu7, Osman Nuri Aydın3
1Department of Anesthesiology and Reanimation, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
2Division of Algology, Department of Physical Medicine and Rehabilitation, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
3Division of Algology, Department of Anesthesiology and Reanimation, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
4Department of Physical Medicine and Rehabilitation, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
5Department of Neurosurgery, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
6Division of Algology, Department of Neurology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
7Department of Radiology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
Keywords: Fluoroscopy, three-dimensional imaging angiography; transforaminal anterior epidural steroid injection.
Abstract
Objectives: Demonstrate of accidental intravascular injection during lumbar transforaminal anterior epidural steroid injection (TAESI) performed with three-dimensional imaging angiography (3DIA) and fluoroscopy.
Methods: We assessed 20 (9 males and 11 females) patients (with a total of 40 levels) whose images were received with simultaneously 3DIA and fluoroscopy-guided TAESI between January 2016 and September 2016 as retrospective. Injections were carried out in the lumbar fourth intervertebral space bilaterally and performed in the same way all of the cases.
Results: The mean age and body mass index of the patients were 47.9±2.72 years and 26.95±1.21, respectively. There were 10 patients with disc herniation, seven patients with spinal stenosis, and three patients with failed back surgery syndrome. In 3D imaging, vascular escape was detected in the 7 levels (17.5%) which were thought to be no escape in the fluoroscopy imaging.
Conclusion: In chronic lumbar radiculopathy patients, intravascular escapes may occur during the fluoroscopic TAESI procedure. To avoid intravascular injections during TAESI procedure, it may be appropriate to use different imaging methods that can give more detailed results such as 3D angiography.