Enhancing contrast distribution with the far lateral approach in lumbar transforaminal epidural steroid injections: A retrospective analysis.

IF 2.5 3区医学 Q2 ANESTHESIOLOGY Pain Practice Pub Date : 2024-07-01 DOI:10.1111/papr.13397

Ying-Wei Yang, Chia-Shiang Lin, Hsuan-Chih Lao, Ying-Chun Lin

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Abstract

Background: Herniated intervertebral disc (HIVD) with radiculopathy is a common degenerative spine disorder. Transforaminal epidural steroid injection (TFESI) is one of the pain relief treatments for lumbar radiculopathy recommended by evidence-based guidelines. Adequate contrast distribution is correlated with better pain control, but the best approach has not been confirmed yet.

Aim: To confirm the distribution of contrast medium injected with a new approach of TFESI, that is, far lateral lateral recess approach (FLLR-TFESI).

Methods: Patients receiving TFESI due to HIVD with radiculopathy between 2010 January and 2020 August were retrospectively enrolled. While the FLLR-TFESI was taken as the experimental group, the conventional approach was viewed as the control group. The baseline characteristics, the pattern of contrast enhancement under fluoroscopic guidance, and the complications of these patients were collected and analyzed.

Results: A total of 380 patients were analyzed (143 in control group and 237 in experimental group). The two groups were balanced in most baseline characteristics, except disc extrusion (p = 0.01) and scoliosis (p = 0.04). The FLLR-TFESI have a better contrast distribution (p < 0.01), even after adjustment (p < 0.001). No intrathecal injection was noted, but higher rate of intra-disc injection was noted in FLLR-TFESI group (10% vs. 3%, p = 0.008).

Conclusion: The FLLR-TFESI has a superior contrast enhancement and distribution in comparison to conventional approach. Prospective study to confirm the study result as well as the clinical benefits is suggested in the future.

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在腰椎穿孔硬膜外类固醇注射中使用远外侧入路增强造影剂分布：回顾性分析。

背景：腰椎间盘突出症（HIVD）伴有神经根病是一种常见的脊柱退行性疾病。经椎间孔硬膜外注射类固醇（TFESI）是循证指南推荐的腰椎病止痛治疗方法之一。充分的造影剂分布与更好的疼痛控制相关，但最佳的方法尚未得到证实。目的：证实用一种新的 TFESI 方法，即远外侧侧凹方法（FLLR-TFESI）注射造影剂的分布：方法：对 2010 年 1 月至 2020 年 8 月间因 HIVD 而接受 TFESI 并伴有根状神经病变的患者进行回顾性登记。将 FLLR-TFESI 作为实验组，传统方法作为对照组。收集并分析了这些患者的基线特征、透视引导下的造影剂增强模式以及并发症：共分析了 380 例患者（对照组 143 例，实验组 237 例）。除椎间盘突出（P = 0.01）和脊柱侧弯（P = 0.04）外，两组在大多数基线特征上是平衡的。FLLR-TFESI 的对比度分布更好（p 结论：FLLR-TFESI 的对比度分布更好：与传统方法相比，FLLR-TFESI 在对比度增强和分布方面更胜一筹。建议今后开展前瞻性研究，以确认研究结果和临床益处。

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来源期刊

Pain Practice ANESTHESIOLOGY-CLINICAL NEUROLOGY

CiteScore

5.60

自引率

3.80%

发文量

审稿时长

6-12 weeks

期刊介绍： Pain Practice, the official journal of the World Institute of Pain, publishes international multidisciplinary articles on pain and analgesia that provide its readership with up-to-date research, evaluation methods, and techniques for pain management. Special sections including the Consultant’s Corner, Images in Pain Practice, Case Studies from Mayo, Tutorials, and the Evidence-Based Medicine combine to give pain researchers, pain clinicians and pain fellows in training a systematic approach to continuing education in pain medicine. Prior to publication, all articles and reviews undergo peer review by at least two experts in the field.