Johnson B A, Schellhas K P, Pollei S R
Center for Diagnostic Imaging, St Louis Park, MN 55416, USA.
AJNR Am J Neuroradiol. 1999 Apr;20(4):697-705.
Even in experienced hands, blind epidural steroid injections result in inaccurate needle placement in up to 30% of cases. The use of fluoroscopy and radiologic contrast material provides confirmation of accurate needle placement within the epidural space. We describe our technique and experience with contrast epidurography and therapeutic epidural steroid injections, and review the frequency of systemic and neurologic complications.
Epidural steroid injections were performed in 5489 consecutive outpatients over a period of 5 1/2 years by three procedural neuroradiologists. In 155 cases (2.8%), the injections were done without contrast material owing to either confirmed or suspected allergy. The remaining 5334 injections were performed after epidurography through the same needle. Patients and referring clinicians were instructed to contact us first regarding complications or any problem potentially related to the injection. In addition, the referring clinicians' offices were instructed to contact us regarding any conceivable procedure-related complications.
Only 10 patients in the entire series required either oral (n = 5) or intravenous (n = 5) sedation. Four complications (0.07%) required either transport to an emergency room (n = 2) or hospitalization (n = 2). None of the complications required surgical intervention, and all were self-limited with regard to symptoms and imaging manifestations. Fluoroscopic needle placement and epidurography provided visual confirmation of accurate needle placement, distribution of the injectate, and depiction of epidural space disease.
Epidurography in conjunction with epidural steroid injections provides for safe and accurate therapeutic injection and is associated with an exceedingly low frequency of untoward sequelae. It can be performed safely on an outpatient basis and does not require sedation or special monitoring.
即便由经验丰富的医生操作，盲法硬膜外类固醇注射仍有高达30%的病例出现针头放置不准确的情况。使用荧光镜检查和放射学造影剂可确认针头在硬膜外间隙的准确放置。我们描述了我们在造影硬膜外造影术和治疗性硬膜外类固醇注射方面的技术和经验，并回顾了全身和神经系统并发症的发生率。
在5年半的时间里，3名神经放射介入医生为5489例连续门诊患者进行了硬膜外类固醇注射。在155例（2.8%）病例中，由于确诊或疑似过敏，注射未使用造影剂。其余5334例注射是在通过同一根针头进行硬膜外造影术后进行的。患者及转诊临床医生被指示，若出现并发症或任何可能与注射相关的问题，应首先联系我们。此外，还指示转诊临床医生办公室就任何可想到的与操作相关的并发症联系我们。
在整个系列中，只有10例患者需要口服（n = 5）或静脉（n = 5）镇静。4例并发症（0.07%）需要转运至急诊室（n = 2）或住院治疗（n = 2）。所有并发症均无需手术干预，且症状和影像学表现均为自限性。荧光镜下针头放置和硬膜外造影可直观确认针头放置准确、注射剂分布情况以及硬膜外间隙疾病的描绘。
硬膜外造影术联合硬膜外类固醇注射可实现安全、准确的治疗性注射，且不良后遗症的发生率极低。该操作可在门诊安全进行，无需镇静或特殊监测。
