Dere Kamer, Akbas Mert, Bicerer Enis, Ozkan Sezai, Dagli Guner
Department of Anaesthesiology, Division of Algology, GATA Haydarpaşa Training Hospital, Istanbul, Turkey.
J Back Musculoskelet Rehabil. 2009;22(4):227-9. doi: 10.3233/BMR-2009-0236.
Epidural injections in the lumbar spine are provided by caudal, lumbar interlaminar or transforaminal routes. Caudal epidural steroid injections are often used for low back pain. Fluoroscopic guidance has been frequently cited as a requirement for this procedure. In this case report, we demonstrate the importance of fluoroscopic guidance during caudal epidural injection.
A 60 years old male patient was admitted to our Algology Department for low back pain. After physical examination caudal epidural steroid injection was planned. The caudal space was identified under fluoroscopic control initially using an anteroposterior projection. After the resultant epidurogram demonstrated vascular spread along the caudal epidural space the needle was withdrawn and the procedure was completed after reinserting the needle.
A careful real time fluoroscopic monitoring should be applied with the injection of opaque material to minimize the risk of vascular injection.
腰椎硬膜外注射可通过骶管、腰椎椎板间或经椎间孔途径进行。骶管硬膜外类固醇注射常用于治疗腰痛。荧光镜引导常被认为是该操作的必要条件。在本病例报告中,我们展示了骶管硬膜外注射时荧光镜引导的重要性。
一名60岁男性患者因腰痛入住我们的疼痛科。体格检查后计划进行骶管硬膜外类固醇注射。最初在荧光镜控制下使用前后位投照确定骶管间隙。在所得硬膜外造影显示血管沿骶管硬膜外间隙扩散后,拔出针头,重新插入针头后完成操作。
在注射不透光材料时应进行仔细的实时荧光镜监测,以尽量降低血管内注射的风险。