Jeong Young Cheol, Lee Chung Ho, Kang Seok, Yoon Joon Shik
Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea.
Ann Rehabil Med. 2017 Jun;41(3):413-420. doi: 10.5535/arm.2017.41.3.413. Epub 2017 Jun 29.
To observe the contrast spread in superoposterior transforaminal epidural steroid injection (SP TFESI) and investigate the correlation between spread patterns and efficacy.
Thirty-one patients with lumbosacral radiculopathy underwent single-level TFESI under fluoroscopy. The final needle tip position was targeted toward the SP quadrant of the intervertebral foramen. To observe the spread, 1 mL of contrast material was injected, followed by a steroid injection. The contrast spread was graded anteroposteriorly and vertically in the epidural space. The effect of SP TFESI was evaluated by proportional pain score reduction.
Levels injected were L4-5 (n=20) and L5-S1 (n=11). Seventeen cases were lateral, and 14 were central herniated disc (HD). Baseline mean visual analog scale score was 6.23. Contrast dispersed dorsally in all the cases, and 45.2% cases showed a concurrent ventral spread. The proportion of the pain reduction after 2 weeks showed no difference between the two groups. In vertical spreading analysis, mean cephalic/caudal grades were 1.40/1.55 at L4-5 level and 1.73/1.64 at L5-S1 level. The HD location had no effect on contrast dispersion.
In SP TFESI, ventral contrast spread did not guarantee a better effect; however, the extent of cephalic flow in ventral expansion group correlated with the proportion of pain reduction.
观察经椎间孔后上入路硬膜外类固醇注射（SP TFESI）时造影剂的扩散情况，并研究扩散模式与疗效之间的相关性。
31例腰骶神经根病患者在透视引导下接受单节段TFESI。最终针尖位置靶向椎间孔的SP象限。为观察扩散情况，先注射1 mL造影剂，然后注射类固醇。在硬膜外间隙对造影剂扩散进行前后位和垂直方向分级。通过疼痛评分降低比例评估SP TFESI的效果。
注射节段为L4-5（n=20）和L5-S1（n=11）。17例为外侧型，14例为中央型椎间盘突出症（HD）。基线平均视觉模拟量表评分为6.23。所有病例造影剂均向背侧扩散，45.2%的病例同时向腹侧扩散。两组2周后疼痛减轻的比例无差异。在垂直扩散分析中，L4-5节段头侧/尾侧平均分级为1.40/1.55，L5-S1节段为1.73/1.64。HD位置对造影剂扩散无影响。
在SP TFESI中，腹侧造影剂扩散并不保证更好的效果；然而，腹侧扩展组中头侧流动的程度与疼痛减轻的比例相关。
