From the Department of Radiology (T.J.A., E.B., P.G.K.) and Department of Biostatistics and Bioinformatics (R.L., S.L.), Duke University Medical Center, Box 3808, Box 3850 Durham, NC 27710; Department of Radiology, University of Pittsburgh Medical Center, St. Margaret Hospital, Pittsburgh, Pa (S.V.); and Department of Radiology, University of North Carolina-Chapel Hill, Chapel Hill, NC (P.P.).
Radiology. 2019 Sep;292(3):723-729. doi: 10.1148/radiol.2019182795. Epub 2019 Jul 16.
Background Previous studies analyzed contrast agent spread during cervical interlaminar epidural steroid injections (CILESIs) by using planar fluoroscopy and reported wide variance of the rate of spread to the ventral epidural space (VES). Cross-sectional CT allows for direct viewing of contrast agent in the VES, providing improved spread assessment and thereby informing needle placement decisions when targeting pain generators. Purpose To determine the extent of injectate spread at CT fluoroscopy-guided CILESI, with particular attention to the VES and bilateral neuroforamina, by using cross-sectional CT. Materials and Methods This study reviewed 83 consecutive CT fluoroscopy-guided CILESIs at which a postprocedural cervical spine CT was performed (June 2016 to December 2017). All procedures used the same injectate (2 mL corticosteroid, 3 mL contrast agent). Postprocedural CT scans were reviewed for the presence of contrast within the VES, dorsal epidural space, ipsilateral neuroforamen, and contralateral neuroforamen in every cervical interlaminar level. Descriptive data are presented as frequencies or means. McNemar tests or hierarchical logistic models were used to assess associations between covariates and contrast agent spread to particular locations. Results The study cohort included 73 individual patients (59% women; 43 of 73) (mean patient age, 57.6 years ± 11.5 [standard deviation]). Mean number of levels of cranial spread were 0.6 level for VES, 1.9 levels for contralateral neuroforamen, 2.1 levels for ipsilateral neuroforamen, and 3 levels for dorsal epidural space. No VES spread in any level was found with 35% (29 of 83) of injections. VES spread was more likely to occur in the level of needle placement (43%; 36 of 83) than in other interlaminar levels (19.5%; 97 of 498; < .001). Spread was more likely to occur in the neuroforamen ipsilateral to the needle approach compared with contralateral ( < .001). Conclusion Cervical interlaminar epidural steroid injections have injectate spreads with a mean of less than one level cranially in the ventral epidural space (VES) and approximately two levels in the neuroforamen. VES spread occurs more frequently at the level of needle placement and within the ipsilateral neuroforamen. © RSNA, 2019.
背景 先前的研究通过平面透视分析了颈椎层间硬膜外类固醇注射（CILESIs）过程中对比剂的扩散情况，并报告了扩散到腹侧硬膜外间隙（VES）的速度差异很大。当针对疼痛发生器进行定位时，横截面 CT 可直接观察到 VES 中的对比剂，从而提供更好的扩散评估，并为针头放置决策提供信息。目的 本研究旨在通过横截面 CT 确定 CT 透视引导下 CILESIs 时的注射剂扩散程度，特别关注 VES 和双侧神经孔。材料与方法 本研究回顾性分析了 2016 年 6 月至 2017 年 12 月期间连续 83 例接受 CT 透视引导下 CILESIs 的患者的资料（n=83）。所有手术均使用相同的注射剂（2 mL 皮质类固醇，3 mL 对比剂）。对术后颈椎 CT 扫描进行评估，以确定 VES、背侧硬膜外间隙、同侧神经孔和对侧神经孔内是否存在对比剂。描述性数据以频率或平均值表示。采用 McNemar 检验或分层逻辑模型评估协变量与特定部位对比剂扩散之间的关系。结果 研究队列包括 73 名患者（59%为女性[43/73]）（平均患者年龄为 57.6 岁±11.5 岁[标准差]）。VES 水平的平均扩展颅侧数量为 0.6 个水平，对侧神经孔为 1.9 个水平，同侧神经孔为 2.1 个水平，背侧硬膜外间隙为 3 个水平。35%（29/83）的注射剂在任何水平均未见 VES 扩散。与其他层间水平（19.5%，97/498；<.001）相比，在针头放置水平（43%，36/83）更可能发生 VES 扩散。与对侧相比，同侧神经孔更容易发生扩散（<.001）。结论 颈椎层间硬膜外类固醇注射的注射剂扩散程度平均在 VES 颅侧不到 1 个水平，在神经孔约 2 个水平。VES 扩散更常见于针头放置水平和同侧神经孔内。
