Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA.
Spine (Phila Pa 1976). 2009 Oct 1;34(21):E751-5. doi: 10.1097/BRS.0b013e3181b043d1.
Prospective, observational in vivo study.
The aim of this study was to determine the incidence of simultaneous epidural and vascular contrast injection during cervical transforaminal epidural injections.
In the lumbar spine, vascular contrast patterns are more than twice as likely to appear simultaneous to the anticipated epidural pattern, than they are to occur alone. This is important because practitioners are more likely to miss a vascular pattern when it appears simultaneous to the expected epidural flow. The incidence of intravascular penetration in cervical transforaminal epidural injections is known to exceed than that of lumbar injections, however, no study has determined the incidence of simultaneous epidural and vascular injection in the cervical spine.
Contrast patterns were observed with live fluoroscopy during 121 injections performed on 82 patients and categorized as one of the following: epidural only, vascular only, or simultaneous epidural and vascular.
The incidence of simultaneous epidural and vascular injection during cervical transforaminal epidural injections was 18.9%. The incidence of vascular only injection was 13.9%, for a total vascular injection incidence of 32.8%. There was no correlation between the observed contrast pattern with patients' age, sex, side of injection, needle gauge, or diagnosis. There was a significant correlation between the level of injection and the risk of vascular injection. The higher the injection level, the higher the probability of a vascular injection. Fluoroscopy time was significantly increased when a vascular injection was identified.
Simultaneous epidural and vascular injection accounts for over half of all vascular injections during cervical transforaminal epidural injections. With the risk of severe complications and high incidence of vascular injections in the cervical spine, live fluoroscopy is recommended during contrast injection with specific attention to simultaneous epidural and vascular flow.
前瞻性、观察性体内研究。
本研究旨在确定颈椎椎间孔硬膜外注射时同时出现硬膜外和血管对比注射的发生率。
在腰椎，血管对比模式同时出现硬膜外预期模式的可能性是单独出现的两倍以上。这很重要，因为当血管模式与预期的硬膜外血流同时出现时，医生更有可能错过血管模式。已知颈椎椎间孔硬膜外注射的血管内穿透发生率高于腰椎注射，但尚无研究确定颈椎硬膜外和血管同时注射的发生率。
在 82 名患者的 121 次注射过程中，使用实时透视观察对比模式，并将其分为以下几种：硬膜外注射、血管注射或同时硬膜外和血管注射。
颈椎椎间孔硬膜外注射时同时出现硬膜外和血管注射的发生率为 18.9%。仅血管注射的发生率为 13.9%，总血管注射发生率为 32.8%。观察到的对比模式与患者年龄、性别、注射侧、针号或诊断之间无相关性。注射水平与血管注射风险之间存在显著相关性。注射水平越高，血管注射的概率越高。当发现血管注射时，透视时间明显增加。
在颈椎椎间孔硬膜外注射中，同时出现硬膜外和血管注射占所有血管注射的一半以上。由于颈椎严重并发症的风险和高血管注射发生率，建议在对比注射时使用实时透视，并特别注意同时出现的硬膜外和血管血流。
