Husseini Jad S, Simeone F Joseph, Staffa Steven J, Palmer William E, Chang Connie Y
Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA, USA.
Harvard Medical School, Boston, MA.
Acta Radiol. 2020 Nov;61(11):1534-1540. doi: 10.1177/0284185120903450. Epub 2020 Feb 12.
Inadvertent intravascular injection is a rare but catastrophic complication of lumbar epidural injections.
To determine risk factors for inadvertent intravascular injection in fluoroscopically guided lumbar spine epidural injections.
A total of 212 patients who presented for lumbar interlaminar or transforaminal injection were prospectively enrolled. Patient demographics, history of surgery, injection side, site and approach, and volume of contrast injected were recorded.
There were 89 (42%) interlaminar and 123 (58%) transforaminal injections. For 36 (17%) patients, there had been surgery at the injected or adjacent lumbar level. There were 25 (12%) inadvertent intravascular injections, with an incidence of 2/93 (2%) for interlaminar and 23/119 (19%) for transforaminal injections. The patients with inadvertent intravascular injection were older ( = 0.017) and had prior surgery at or adjacent to the level of injection ( < 0.0001). Transforaminal approach had a higher intravasation rate than interlaminar injections, both when comparing the entire cohort ( = 0.0001) and only patients without prior surgery ( = 0.01). In multivariable logistic regression analysis, transforaminal injections (odds ratio [OR] 9.77, 95% confidence interval [CI] 2.14-44.6, = 0.003) and prior surgery at or adjacent to the level of injection (OR 5.71, 95% CI 2.15-15.15, < 0.001) were independently associated with increased risk of inadvertent intravascular injections.
Inadvertent intravascular injection occurred in 12% of our lumbar injection cohort and is more common with transforaminal injections, in older patients, and with prior lumbar surgery at or adjacent to the level of injection.
意外血管内注射是腰椎硬膜外注射一种罕见但灾难性的并发症。
确定在荧光透视引导下腰椎硬膜外注射时意外血管内注射的危险因素。
前瞻性纳入了总共212例行腰椎椎间孔或经椎间孔注射的患者。记录患者的人口统计学资料、手术史、注射侧、部位和入路以及注入造影剂的量。
有89例（42%）为椎间孔注射，123例（58%）为经椎间孔注射。36例（17%）患者在注射的腰椎节段或相邻节段有过手术。有25例（12%）意外血管内注射，其中椎间孔注射的发生率为2/93（2%），经椎间孔注射的发生率为23/119（19%）。意外血管内注射的患者年龄较大（P = 0.017），且在注射节段或相邻节段有过手术（P < 0.0001）。无论是比较整个队列（P = 0.0001）还是仅比较无既往手术的患者（P = 0.01），经椎间孔入路的血管内注射率均高于椎间孔注射。在多变量逻辑回归分析中，经椎间孔注射（比值比[OR] 9.77，95%置信区间[CI] 2.14 - 44.6，P = 0.003）以及在注射节段或相邻节段有过手术（OR 5.71，95% CI 2.15 - 15.15，P < 0.001）与意外血管内注射风险增加独立相关。
在我们的腰椎注射队列中，12%的患者发生了意外血管内注射，在经椎间孔注射、老年患者以及在注射节段或相邻节段有过腰椎手术的患者中更为常见。
