Lazarus Matthew S, Forman Rebecca B, Brook Alan L, Miller Todd S
Montefiore Medical Center, Bronx, NY.
Albert Einstein College of Medicine, Bronx, NY.
Pain Physician. 2017 May;20(4):E585-E591.
Image guidance for spine pain control procedures, including epidural steroid injection, nerve root block, and facet block, can be performed with either computed tomography (CT) or conventional fluoroscopy. CT has the advantage of improved anatomic localization and use of air for contrast; however, there are concerns that CT leads to higher radiation dose and longer procedure time.
To evaluate procedure time and radiation dose for multiple types of spine pain control procedures performed under CT guidance.
Retrospective evaluation.
Department of radiology in single academic medical center.
Institutional review board approval was obtained. We reviewed CT-guided spine procedures performed over a 12-month period from January 2012 to December 2012. Procedure type, procedure time, and dose-length product were recorded. Patient age and gender were recorded for each case; additionally, demographic and medical history data were obtained for a sub-group of patients.
Nine hundred ninety-four studies (performed in 699 patients) were reviewed, including 585 epidural steroid injections, 228 nerve root blocks, and 90 facet blocks. For all studies, procedure time averaged 7:34 ± 5:05, and dose-length product averaged 75 mGy·cm ± 61. Additional medical history (available for 483 patients) revealed high rate of obesity (body mass index [BMI] = 30 ± 6.8, with 76% of patients overweight [BMI > 25] and 42% obese [BMI > 30]), and frequent medical comorbidities (including hypertension [n = 179], diabetes [n = 101], renal failure [n = 30], and heart failure [n = 17]).
This study was performed retrospectively, and limited to a single institution.
These findings add to the growing evidence that CT guidance is a safe and effective technique for epidural steroid injection. These results further demonstrate that other spine intervention procedures, including nerve root block and facet block, can also be performed under CT guidance with short procedure time and reasonable levels of radiation exposure. This approach can be effectively used in a patient population with a high rate of obesity and medical comorbidities.
脊柱疼痛控制手术的影像引导，包括硬膜外类固醇注射、神经根阻滞和小关节阻滞，可通过计算机断层扫描（CT）或传统荧光透视法进行。CT具有改善解剖定位和使用空气作为对比剂的优势；然而，有人担心CT会导致更高的辐射剂量和更长的手术时间。
评估在CT引导下进行的多种类型脊柱疼痛控制手术的手术时间和辐射剂量。
回顾性评估。
单一学术医疗中心的放射科。
获得机构审查委员会的批准。我们回顾了2012年1月至2012年12月期间进行的CT引导下的脊柱手术。记录手术类型、手术时间和剂量长度乘积。记录每个病例的患者年龄和性别；此外，还获取了一组患者的人口统计学和病史数据。
共回顾了994项研究（在699名患者中进行），包括585次硬膜外类固醇注射、228次神经根阻滞和90次小关节阻滞。所有研究的平均手术时间为7:34±5:05，剂量长度乘积平均为75 mGy·cm±61。其他病史（483名患者可获取）显示肥胖率较高（体重指数[BMI]=30±6.8，76%的患者超重[BMI>25]，42%肥胖[BMI>30]），且常有合并症（包括高血压[n = 179]、糖尿病[n = 101]、肾衰竭[n = 30]和心力衰竭[n = 17]）。
本研究为回顾性研究，且限于单一机构。
这些发现进一步证明了CT引导是硬膜外类固醇注射的一种安全有效的技术。这些结果进一步表明，其他脊柱介入手术，包括神经根阻滞和小关节阻滞，也可在CT引导下进行，手术时间短，辐射暴露水平合理。这种方法可有效应用于肥胖率和合并症发生率较高的患者群体。
