Nikooseresht Mahshid, Hashemi Masoud, Mohajerani Seyed Amir, Shahandeh Farideh, Agah Mahvash
Department of Anesthesiology, Hamadan University of Medical Sciences, Hamedan, Iran.
Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Iran J Radiol. 2014 May;11(2):e13262. doi: 10.5812/iranjradiol.13262. Epub 2014 May 15.
The caudal approach to the epidural space has been used for decades to treat low back pain caused by lumbosacral root compression. The use of fluoroscopy during epidural steroid injection is the preferred method for placing the needle more accurately in the sacral hiatus, but it carries the risk of radiation hazard.
The aim of the study was to assess the anatomical structure of the sacral hiatus and the feasibility of caudal epidural injections under ultrasound guidance.
Two hundred and forty patients (male = 100, female = 140) with low back pain and sciatica who were candidates for caudal epidural injection were enrolled into this study. Ultrasound images of the sacral hiatus and bilateral cornua were obtained by a real-time linear array ultrasound transducer. The distance between bilateral cornua and the anterior and posterior wall of the sacrum were measured at the base (sacral hiatus). Under the guide of ultrasonography, we defined the injection successful if turbulence of medication fluid was observed in the sacral canal, but correct placement of the needle and injectant was confirmed on fluoroscopic view as the gold standard technique.
The epidurogram showed that the injection was successful in 230 of the 240 patients (95.8%). In eight patients, the injection was not in the correct place in the sacral canal. The sacral hiatus could not be identified by ultrasound images in only two patients who had a closed sacral hiatus identified by fluoroscopy. The mean distance of the sacral hiatus was 4.7 ± 1.7 mm and the mean distance between bilateral cornua was 18.0 ± 2.8 mm. The mean duration of the procedure was 10.8 ± 6.8 minutes. No major complication was observed in the next month.
In conclusion, ultrasound could be used as a safe, fast and reliable modality to observe the anatomic variation of the sacral hiatus and to perform caudal epidural injections.
骶管硬膜外腔入路已被用于治疗腰骶神经根受压引起的下腰痛数十年。在硬膜外类固醇注射过程中使用荧光透视是将针更准确地置于骶裂孔的首选方法，但存在辐射危害风险。
本研究旨在评估骶裂孔的解剖结构以及超声引导下骶管硬膜外注射的可行性。
本研究纳入了240例因下腰痛和坐骨神经痛而拟行骶管硬膜外注射的患者（男性100例，女性140例）。使用实时线性阵列超声换能器获取骶裂孔及双侧角的超声图像。在骶裂孔底部测量双侧角与骶骨前后壁之间的距离。在超声引导下，若观察到药液在骶管内出现湍流则定义为注射成功，但以荧光透视下确认针和注射剂的正确位置作为金标准技术。
硬膜外造影显示，240例患者中有230例（95.8%）注射成功。8例患者的注射位置不在骶管内的正确位置。仅2例通过荧光透视确定为闭合性骶裂孔的患者，其超声图像未能识别出骶裂孔。骶裂孔的平均距离为4.7±1.7mm，双侧角之间的平均距离为18.0±2.8mm。该操作的平均持续时间为10.8±6.8分钟。在接下来的一个月内未观察到重大并发症。
总之，超声可作为一种安全、快速且可靠的方式来观察骶裂孔的解剖变异并进行骶管硬膜外注射。
