Lee Jongseok, Jo Daehyun, Song Shinmi, Park Dahee, Kim Dohyeong, Oh Jinyoung
Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Pain Center, Pohang Wooridul Hospital, Pohang-si, Gyeongsangbuk-do, Republic of Korea.
J Pain Res. 2020 Nov 10;13:2869-2878. doi: 10.2147/JPR.S270450. eCollection 2020.
Dispersion of contrast media into the anterior epidural space is correlated with better outcomes after transforaminal epidural injection (TFEI). Needle tip position is an important factor affecting the pattern of contrast media dispersion. It is difficult to advance the needle medially to the interpedicle line with a conventional approach, especially in a severe spinal stenosis. But, with Kambin's triangle approach, the needle can be advanced more medially even in the severe stenosis. We aimed to compare contrast media dispersion patterns according to the needle tip position in TFEI with Kambin's triangle approach.
This single-center retrospective study analyzed fluoroscopic data of patients who underwent TFEI from March 2019 to July 2019. Data on the history of lumbar spinal fusion surgery and MRI findings were collected. The needle tip position was evaluated in three positions on fluoroscopic images (final anteroposterior [AP] view): extraforaminal (EF), lateral foramen (LF), and medial foramen (MF). Contrast media dispersion into the epidural space (epidural pattern) in the AP view was evaluated as a dependent variable. The relationship between the contrast media dispersion pattern and needle tip position was analyzed, and other factors affecting the contrast media dispersion pattern were identified.
Ninety-eight TFEI cases were analyzed (51 LF, 35 MF, and 12 EF). An epidural pattern of dispersion was observed more frequently in the LF and MF groups than in the EF group. The LF and MF groups showed no significant difference in epidural pattern frequency. On logistic regression analysis, needle tip position emerged as a major factor influencing epidural pattern, while other factors including spine conditions had no significant effect.
Positioning the needle tip medial to the pedicle helps in the spread of the contrast media into the epidural space during TFEI with Kambin's approach. Factors other than the needle tip position did not significantly affect the contrast media dispersion pattern.
造影剂在前硬膜外间隙的扩散与经椎间孔硬膜外注射（TFEI）后的更好预后相关。针尖位置是影响造影剂扩散模式的一个重要因素。采用传统方法很难将针向内侧推进到椎弓根间线，尤其是在严重的椎管狭窄病例中。但是，采用坎宾三角入路，即使在严重狭窄的情况下，针也可以更向内侧推进。我们旨在比较采用坎宾三角入路进行TFEI时，根据针尖位置不同的造影剂扩散模式。
这项单中心回顾性研究分析了2019年3月至2019年7月接受TFEI的患者的透视数据。收集了腰椎融合手术史和MRI检查结果的数据。在透视图像上的三个位置（最终前后位[AP]视图）评估针尖位置：椎间孔外（EF）、侧隐窝（LF）和椎间孔内（MF）。将AP视图中造影剂向硬膜外间隙的扩散（硬膜外模式）作为因变量进行评估。分析造影剂扩散模式与针尖位置之间的关系，并确定影响造影剂扩散模式的其他因素。
分析了98例TFEI病例（51例LF、35例MF和12例EF）。LF组和MF组比EF组更频繁地观察到硬膜外扩散模式。LF组和MF组在硬膜外模式频率上无显著差异。经逻辑回归分析，针尖位置是影响硬膜外模式的主要因素，而包括脊柱状况在内的其他因素无显著影响。
采用坎宾入路进行TFEI时，将针尖置于椎弓根内侧有助于造影剂扩散到硬膜外间隙。除针尖位置外的其他因素对造影剂扩散模式无显著影响。
