Hong JiHee, Jung Sungwon, Chang Hyuckwon
Departments of Anesthesiology and Pain Medicine; Psychiatry; and Radiology, Keimyung University Dong San Hospital, Dae Gu, Korea.
Pain Physician. 2015 Jul-Aug;18(4):325-31.
Transforaminal epidural steroid injection (TFESI) is a commonly used interventional pain management procedures to treat radicular leg pain. Although most reported complications of TFESI are minor, serious morbidity has also been demonstrated including spinal cord infarction, paraplegia, and quadriparesis. Suggested mechanisms include direct vascular injury or intravascular injection of particulate steroid.
We compared 2 different needle types, Whitacre and Quincke type needles, with regard to intravascular injection rate with total procedure time and the amount of radiation during lumbar TFESI.
Prospective, randomized trial.
An interventional pain management practice in South Korea.
After Institutional Review Board approval, 149 patients undergoing lumbar TFESI for radicular leg pain were randomly assigned to one of 2 needle groups (Whitacre needle or Quincke type needle). After final confirmation of intravascular injection with digital subtraction angiography, total procedure time and amount of radiation exposure during TFESI were measured.
The overall incidence of intravascular injection was 10.4% (28/269). We analyzed the overall incidence of intravascular injection according to the 2 different needle types. The incidence of intravascular injection of the Whitacre needle was 5.4% (8/146), whereas the incidence of intravascular injection of the Quincke needle was 16.2% (20/123). Total procedure time and amount of radiation required to complete the TFESI in the Whitacre and Quincke needle groups was 168.4 ± 57.9 (seconds) and 33.4 ± 15.9 (cGy/cm2), 131.9 ± 46.0 (seconds) and 33.2 ± 15.8 (cGy/cm2), respectively.
The physician who performed the TFESI was not blinded to the type of needle for detecting intravascular injection. This study was focused on lumbar TFESI, however, most TFESIs are performed at the L4-5 or L5-S1 level.
The Whitacre needle had the benefit of reducing the incidence of intravascular injection with minimal differences in technical difficulties and the amount of radiation exposure during lumbar TFESI.
经椎间孔硬膜外类固醇注射（TFESI）是一种常用的介入性疼痛管理程序，用于治疗腿部放射性疼痛。尽管大多数报道的TFESI并发症较轻，但也有严重的发病情况被证实，包括脊髓梗死、截瘫和四肢瘫。推测的机制包括直接血管损伤或血管内注射颗粒状类固醇。
我们比较了两种不同类型的针，即Whitacre针和Quincke针，在腰椎TFESI过程中的血管内注射率、总操作时间和辐射量。
前瞻性随机试验。
韩国一家介入性疼痛管理诊所。
经机构审查委员会批准后，149例因腿部放射性疼痛接受腰椎TFESI的患者被随机分配到两个针组之一（Whitacre针组或Quincke针组）。在通过数字减影血管造影最终确认血管内注射后，测量TFESI期间的总操作时间和辐射暴露量。
血管内注射的总体发生率为10.4%（28/269）。我们根据两种不同类型的针分析了血管内注射的总体发生率。Whitacre针的血管内注射发生率为5.4%（8/146），而Quincke针的血管内注射发生率为16.2%（20/123）。Whitacre针组和Quincke针组完成TFESI所需的总操作时间和辐射量分别为168.4±57.9（秒）和33.4±15.9（cGy/cm²）、131.9±46.0（秒）和33.2±15.8（cGy/cm²）。
进行TFESI的医生在检测血管内注射时对针的类型未设盲。本研究聚焦于腰椎TFESI，然而，大多数TFESI是在L4 - 5或L5 - S1水平进行的。
在腰椎TFESI中，Whitacre针在降低血管内注射发生率方面具有优势，且在技术难度和辐射暴露量方面差异最小。
