Pain Management, Orthopaedic and Spine Specialists, 1855 Powder Mill Road, York, PA 17403, USA.
Pain Med. 2012 Oct;13(10):1265-74. doi: 10.1111/j.1526-4637.2012.01474.x. Epub 2012 Aug 23.
We identify the contrast volumes needed to reach specific landmarks during S1 transforaminal epidural injections (S1-TFEIs).
Prospective, nonrandomized, observational human study. Setting. Academic/private pain management practice. Subjects. Forty-two patients undergoing S1-TFEIs were investigated. Thirty-seven patients were included in this study. Interventions. S1-TFEIs were performed using contrast-enhanced fluoroscopic visualization.
After confirming appropriate spinal needle position, up to 5 mL of nonionic contrast was slowly injected. Under biplanar fluoroscopic guidance, contrast volumes were recorded as flow reached specific anatomic landmarks: the ipsilateral S1 pedicle, the superior aspect of the L5-S1 disc space, and across the midline of the spinous process.
After injecting 2 mL of contrast, 100% of S1-TFEIs spread to the medial aspect of the ipsilateral superior pedicle of S1. After injecting 3.0 mL of contrast, 92% of S1-TFEIs spread to the superior aspect of the L5-S1 intervertebral disc. After injecting 4 mL of contrast, 27% of S1-TFEIs spread beyond the midline of the spinous process, but by only a few millimeters.
This study demonstrates injectate volumes needed to reach specific anatomic landmarks in S1-TFEIs. A volume of 3.0 mL of contrast reaches the superior aspect of the L5-S1 intervertebral disc 92% of the time.
确定 S1 经椎间孔硬膜外注射（S1-TFEI）中到达特定标志所需的对比剂体积。
前瞻性、非随机、观察性人体研究。
学术/私人疼痛管理实践。
接受 S1-TFEI 的 42 名患者进行了调查。
37 名患者纳入本研究。
S1-TFEI 使用增强型荧光透视可视化进行。
在确认适当的脊柱针位置后，缓慢注射多达 5ml 的非离子型对比剂。在双平面荧光透视引导下，当对比剂到达特定解剖标志时记录对比剂体积：同侧 S1 椎弓根的内侧、L5-S1 椎间盘间隙的上侧和棘突的中线。
注射 2ml 对比剂后，100%的 S1-TFEI 扩散到同侧 S1 上椎弓根的内侧。注射 3.0ml 对比剂后，92%的 S1-TFEI 扩散到 L5-S1 椎间盘的上侧。注射 4ml 对比剂后，27%的 S1-TFEI 扩散到棘突中线以外，但只有几毫米。
本研究表明 S1-TFEI 中到达特定解剖标志所需的注射量。3.0ml 体积的对比剂 92%的时间到达 L5-S1 椎间盘的上侧。
