From the *Department of Anesthesiology and Pain Medicine, Seoul-Siwonhan Pain Clinic, Seongnam, Korea; †Department of Anesthesiology and Pain Medicine, Seoul National University Hospital; and ‡Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea.
Anesth Analg. 2013 Nov;117(5):1241-7. doi: 10.1213/ANE.0b013e3182a6d1bd.
Transforaminal epidural steroid injection (TFESI) is a useful treatment modality for pain management. Most complications of TFESI are minor and transient. However, there is a risk of serious complications such as nerve injury, spinal cord infarct, or paraplegia. Some of the risks are related to direct injury to the vessel or intravascular injection of the particulate steroid. We prospectively tested the hypothesis that the intravascular injection rate of the Whitacre needle is lower than that of the Quincke needle during TFESI.
This study was a randomized trial of 1376 TFESIs at the S1 level. We collected data of age, gender, height, weight, laterality (right/left), history of lumbosacral spine operation, history of appropriate interval discontinuation of anticoagulation medicines, and underlying disease. During the S1 TFESI, intrasacral bone contact, a blood aspiration test, and real-time fluoroscopy of the intravascular injection using contrast media were investigated.
There were no significant differences in the intravascular injection rate with respect to age, gender, height, weight, hypertension, diabetes mellitus, laterality, history of lumbosacral spine operation, or history of appropriate interval discontinuation of anticoagulation medicines. Intravascular injection was significantly associated with a blood aspiration test (P < 0.001), needle tip type (P = 0.002), intrasacral bone contact (P < 0.001), and physicians (some P < 0.05). The use of Quincke needles and intrasacral bone contact increased the rate of intravascular injection.
To reduce the risk of intravascular injection, the use of Whitacre needles without intrasacral bone contact may be a safer and more effective approach.
经椎间孔硬膜外类固醇注射（TFESI）是一种用于疼痛管理的有效治疗方式。TFESI 的大多数并发症都是轻微且短暂的。然而，存在严重并发症的风险，如神经损伤、脊髓梗死或截瘫。其中一些风险与血管直接损伤或颗粒类固醇的血管内注射有关。我们前瞻性地检验了这样一个假设，即在 TFESI 过程中，Whitacre 针的血管内注射率低于 Quincke 针。
这是一项在 S1 水平进行的 1376 例 TFESI 的随机试验。我们收集了年龄、性别、身高、体重、侧别（右侧/左侧）、腰骶部脊柱手术史、适当间隔停止抗凝药物史以及基础疾病的数据。在 S1 TFESI 期间，我们研究了骶骨内骨接触、血液抽吸试验以及使用对比剂的实时血管内注射透视。
在血管内注射率方面，年龄、性别、身高、体重、高血压、糖尿病、侧别、腰骶部脊柱手术史或适当间隔停止抗凝药物史无显著差异。血管内注射与血液抽吸试验（P < 0.001）、针尖类型（P = 0.002）、骶骨内骨接触（P < 0.001）和医生（部分 P < 0.05）显著相关。使用 Quincke 针和骶骨内骨接触会增加血管内注射的发生率。
为了降低血管内注射的风险，使用 Whitacre 针且不接触骶骨可能是一种更安全、更有效的方法。
