Evaluation of Epidurographic Contrast Patterns with Fluoroscopic‐Guided Lumbar Interlaminar Ventral Epidural Injection

Abstract

Targeted ventral epidural steroid injection with a transforaminal approach has been widely used for the treatment of nerve root inflammation and pain. Lumbar interlaminar approach is also commonly used; however, ventral epidural injection may not be obtained properly. Lumbar interlaminar ventral epidural (LIVE) injection can be achieved as the epidural catheter is placed at the ventrolateral side of the nerve root. The purpose of this study is to evaluate the contrast dispersal pattern with LIVE injection. Forty patients with lower back and L5 radicular pain were studied. LIVE injection was performed with an epidural catheter inserted toward the 9 o'clock position (for the right side) or 3 o'clock position (for the left side) of the pedicle, where the catheter tip was placed at the ventrolateral side of the nerve root. A total of 2 mL of contrast was injected to determine the epidurographic pattern. With 1-mL injection, all patients showed excellent filling in the ventral epidural space of L5 nerve root. After a total of 2 mL injection, it showed rostral spread in 26/40 (65%) patients, and caudal spread in 34/40 (85%) patients. None of the patients showed intravascular injection, and no neural complications were reported. The data showed excellent spread of contrast into the nerve root and the ventral epidural space in all patients. There were no inadvertent vascular or neural complications. LIVE approach can be an alternative way to achieve targeted ventral epidural injection.