Incidence of simultaneous epidural and vascular injection during lumbosacral transforaminal epidural injections

Abstract

We were impressed to read the study by Smuck et al. [ [1] Smuck M. Fuller B.J. Yoder B. Huerta J. Incidence of simultaneous epidural and vascular injection during lumbosacral transforaminal epidural injections. Spine J. 2007; 7: 79-82 Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar ] evaluating the incidence of simultaneous epidural and vascular injection during lumbosacral transforaminal epidural injections. This is a novel report, which has not been published earlier. We [ [2] Manchikanti L. Cash K.A. Pampati V. Damron K.S. McManus C.D. Evaluation of lumbar transforaminal epidural injections with needle placement and contrast flow patterns: a prospective, descriptive report. Pain Physician. 2004; 7: 217-223 PubMed Google Scholar ] and others [ 3 Botwin K. Natalicchio J. Brown L.A. Epidurography contrast patterns with fluoroscopic guided lumbar transforaminal epidural injections: a prospective evaluation. Pain Physician. 2004; 7: 211-215 PubMed Google Scholar , 4 Sullivan W.J. Willick S.E. Chira-Adisai W. et al. Incidence of intravascular uptake in lumbar spinal injection procedures. Spine. 2000; 25: 481-486 Crossref PubMed Scopus (100) Google Scholar , 5 Furman M.B. O'Brien E.M. Zgeleszewski T.M. Incidence of intravascular penetration in transforaminal lumbosacral epidural steroid injections. Spine. 2000; 25: 2628-2632 Crossref PubMed Scopus (165) Google Scholar ] have also evaluated this issue. In our study of evaluation of lumbar transforaminal epidural injections with needle placement and contrast flow patterns, we have demonstrated total intravenous placement of the needle in 22% of the procedures, whereas negative flashback and aspiration were noted in only 5% of the procedures. Smuck et al. [ [1] Smuck M. Fuller B.J. Yoder B. Huerta J. Incidence of simultaneous epidural and vascular injection during lumbosacral transforaminal epidural injections. Spine J. 2007; 7: 79-82 Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar ] reported an overall total vascular injection incidence of 13.1% with a simultaneous epidural and vascular injection incidence of 8.9%.