Chang Jason L, Patel Ajay K, Modi Devas J, Johnson Peyton, Mukhdomi Taif, Gulati Amitabh
Department of Rehabilitation & Regenerative Medicine, NewYork-Presbyterian Hospital- University Hospital of Columbia and Cornell, New York, NY, USA.
Department of Anesthesiology, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.
Interv Pain Med. 2022 Feb 12;1(3):100068. doi: 10.1016/j.inpm.2022.100068. eCollection 2022 Sep.
Sacroiliac (SI) joint, S1 and S2 nerve root pathology are well documented in literature as common etiologies for low back pain. Evidence demonstrating starting angle of needle insertion during S1/S2 transforaminal and SI joint injections are lacking. Using computerized tomography (CT) radiography of the lumbosacral spine, this retrospective observational study seeks to characterize a starting angle of needle insertion at the sacral spine.
This was a single-centered, retrospective observational study performed on adult cancer patients who had CT radiography of their lumbosacral spine, without significant sacral pathology, at our hospital from January 2016 and May 2021. For each patient, we determined the anatomical location of where the S1/S2 neural foramen and SI joint widens up. Using the annotation tools available in EIM image viewer, a maximum level and minimum level of insertion was recorded in order to calculate the average angle of insertion needed for procedural performance.
Through the analysis of 64 patients, average angle of insertion was 25° ± 1.36 for S1, 34° ± 1.93 for S2, and 33° ± 1.95 for SI injections. There were no statistically significant differences in angles when stratified based on laterality, gender, age, and BMI.
Average angle of insertion to target the S1, S2 neural foramen and SI joint are 25° ipsilateral oblique, 34° ipsilateral oblique, and 33° contralateral oblique respectively starting with a squared sacral endplate. To our knowledge, there are no studies in the current literature that have attempted to identify an entry angle to target these anatomical structures.
Chronic Pain, SI Joint Pain, Steroid Injection, S1 Transforaminal, S2 Transforaminal, Needle Placement.
文献充分记载，骶髂（SI）关节、S1和S2神经根病变是腰痛的常见病因。但缺乏证据表明S1/S2经椎间孔注射和SI关节注射时的进针起始角度。本回顾性观察研究利用腰骶椎计算机断层扫描（CT）成像，旨在确定骶椎进针的起始角度。
这是一项单中心回顾性观察研究，研究对象为2016年1月至2021年5月期间在我院接受腰骶椎CT成像且无明显骶骨病变的成年癌症患者。对于每位患者，我们确定了S1/S2神经孔和SI关节增宽处的解剖位置。使用EIM图像查看器中的注释工具，记录进针的最高水平和最低水平，以计算操作所需的平均进针角度。
通过对64例患者的分析，S1注射的平均进针角度为25°±1.36，S2注射为34°±1.93，SI关节注射为33°±1.95。根据侧别、性别、年龄和BMI分层时，角度无统计学显著差异。
以方形骶骨终板为起点，靶向S1、S2神经孔和SI关节的平均进针角度分别为同侧倾斜25°、同侧倾斜34°和对侧倾斜33°。据我们所知，目前文献中尚无研究试图确定靶向这些解剖结构的进针角度。
慢性疼痛；SI关节疼痛；类固醇注射；S1经椎间孔；S2经椎间孔；针放置
