Brummett Chad M, Williams Bryan S, Hurley Robert W, Erdek Michael A
Division of Pain Medicine, Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, USA.
Reg Anesth Pain Med. 2009 Mar-Apr;34(2):100-5. doi: 10.1097/AAP.0b013e31819a12ba.
Previous studies have concluded that transforaminal epidural steroid injections (ESIs) are more effective than interlaminar injections in the treatment of radiculopathies due to lumbar intervertebral disk herniation. There are no published studies examining the depth of epidural space using a transforaminal approach. We investigated the relationship between body mass index (BMI) and the depth of the epidural space during lumbar transforaminal ESIs.
Eighty-six consecutive patients undergoing lumbar transforaminal ESI at the L3-L4, L4-L5, and L5-S1 levels were studied. Using standard protocol, the foraminal epidural space was attained using fluoroscopic guidance. The measured distance from needle tip to skin was recorded (depth to foraminal epidural space). The differences in the needle depth and BMI were analyzed using regression analysis.
Needle depth was positively associated with BMI (regression coefficient [RC], 1.13; P < 0.001). The median depths (in centimeters) to the epidural space were 6.3, 7.5, 8.4, 10.0, 10.4, and 12.2 for underweight, normal, preobese, obese I, obese II, and obese III classifications, respectively. Sex (RC, 1.3; P = 0.02) and race (RC, 0.8; P = 0.04) were also significantly associated with needle depth; however, neither factor remained significant when BMI was accounted as a covariate in the regression model. Age, intervertebral level treated, and oblique angle had no predictive value on foraminal depth (P > 0.2).
There is a positive association between BMI and transforaminal epidural depth, but not with age, sex, race, oblique angle, or intervertebral level.
既往研究得出结论，经椎间孔硬膜外类固醇注射（ESI）在治疗腰椎间盘突出症所致神经根病方面比椎板间注射更有效。尚无已发表的研究使用经椎间孔方法检测硬膜外间隙的深度。我们研究了腰椎经椎间孔ESI期间体重指数（BMI）与硬膜外间隙深度之间的关系。
对86例连续在L3-L4、L4-L5和L5-S1水平接受腰椎经椎间孔ESI的患者进行研究。采用标准方案，在荧光透视引导下到达椎间孔硬膜外间隙。记录从针尖到皮肤的测量距离（到椎间孔硬膜外间隙的深度）。使用回归分析分析针深度与BMI的差异。
针深度与BMI呈正相关（回归系数[RC]，1.13；P<0.001）。体重过轻、正常、肥胖前期、I级肥胖、II级肥胖和III级肥胖分类的硬膜外间隙中位深度（厘米）分别为6.3、7.5、8.4、10.0、10.4和12.2。性别（RC，1.3；P = 0.02）和种族（RC，0.8；P = 0.04）也与针深度显著相关；然而，当在回归模型中将BMI作为协变量时，这两个因素均不再显著。年龄、治疗的椎间水平和斜角对椎间孔深度无预测价值（P>0.2）。
BMI与经椎间孔硬膜外深度呈正相关，但与年龄、性别、种族、斜角或椎间水平无关。
