Verrills Paul, Mitchell Bruce, Vivian David, Nowesenitz Gillian, Lovell Brian, Sinclair Chantelle
Metro Spinal Clinic, Caulfield South, Melbourne, Australia.
Spine (Phila Pa 1976). 2008 Mar 15;33(6):E174-7. doi: 10.1097/BRS.0b013e318166f03d.
Clinical observational study.
To quantify the incidence of inadvertent intravascular injections in spinal medial branch blocks in a clinical setting.
Previous research established the rate of inadvertent intravascular injection in lumbar medial branch blocks at 8%. The incidence of intravascular injection in cervical and thoracic medial branch blocks has not been reported previously. This study establishes the rate of inadvertent intravascular injection in patients receiving medial branch blocks of the cervical and thoracic spines. Further, this study reports a significantly lower rate of inadvertent intravascular injection for lumbar medial branch blocks than previously reported.
Patients were originally referred to the clinic, for diagnosis and treatment of chronic spinal origin somatic pain. Medial branch blocks were then performed as diagnostic procedures to confirm the zygapophysial joint(s) as the suspected source of pain. Blocks were performed by experienced practitioners on nonidentified patients over a 3-year period. Clinical observations were recorded for 14,312 separate medial branch block levels. The level of the spine and the incidence of inadvertent intravascular injections were recorded.
This study demonstrates that the overall incidence of intravascular penetration in medial branch blocks is rare, with an overall rate of 3.5%. This study also establishes the rate of intravascular injection for levels within the spine: the cervical spine is likely to be intravascular 3.9% of the time and the lumbar spine 3.7%, whereas the thoracic spine is significantly lower, with just 0.7% injections reported as intravascular. Significant differences were also observed between individual vertebral levels.
The false-negative rate for medial branch blocks is likely to be lower than previously reported. The rate of inadvertent intravascular injection for thoracic medial branch blocks is 0.7%. Cervical and lumbar medial branch blocks are associated with an overall rate of 3.9% and 3.7%, respectively. Although these rates are lower than previously reported, the incidence of false-negative blocks still justifies the use of contrast to confirm nonvascular injection.
临床观察性研究。
在临床环境中量化脊柱内侧支阻滞时意外血管内注射的发生率。
先前的研究确定腰椎内侧支阻滞时意外血管内注射的发生率为8%。颈椎和胸椎内侧支阻滞时血管内注射的发生率此前尚未见报道。本研究确定了接受颈椎和胸椎内侧支阻滞患者的意外血管内注射发生率。此外，本研究报告的腰椎内侧支阻滞意外血管内注射发生率显著低于先前报道。
患者最初因慢性脊柱源性躯体疼痛的诊断和治疗被转诊至诊所。然后进行内侧支阻滞作为诊断程序，以确认关节突关节为可疑疼痛来源。阻滞由经验丰富的从业者在3年期间对身份不明的患者进行。记录了14312个单独的内侧支阻滞水平的临床观察情况。记录脊柱水平和意外血管内注射的发生率。
本研究表明，内侧支阻滞时血管内穿刺的总体发生率很低，总体发生率为3.5%。本研究还确定了脊柱各节段的血管内注射发生率：颈椎血管内注射的可能性为3.9%，腰椎为3.7%，而胸椎显著更低，仅0.7%的注射报告为血管内注射。在各个椎体节段之间也观察到了显著差异。
内侧支阻滞的假阴性率可能低于先前报道。胸椎内侧支阻滞意外血管内注射的发生率为0.7%。颈椎和腰椎内侧支阻滞的总体发生率分别为3.9%和3.7%。尽管这些发生率低于先前报道，但假阴性阻滞的发生率仍证明使用造影剂确认非血管内注射是合理的。
