Abstract
Background. Caudal epidural steroid injections (CESIs) are an effective treatment for pain. If the injection spreads in a specific pattern depending on the needle position or bevel direction, it would be possible to inject the agent into a specific and desired area. Objectives. We conducted a prospective randomized trial to determine if the needle position and bevel direction have any effect on the epidural spreading pattern in CESI. Methods. Demographic data of the patient were collected. During CESI, the needle position (middle or lateral) and direction (ventral or dorsal) were randomly allocated. Following fluoroscope-guided injection of 4 mL contrast media and 10 mL of injectates, the epidural spreading patterns (ventral or dorsal, bilateral or lateral) were imaged. Results. In the 210 CESIs performed, the needle tip position and bevel direction did not influence the epidural spreading patterns at L4-5 and L5-S1 disc levels. A history of Lumbar spine surgery was associated with a significantly limited spread to each disc level. A midline needle tip position was more effective than the lateral position in spreading to the distant disc levels. Conclusions. Neither the needle tip position nor the bevel direction affected the epidural drug spreading pattern during CESI.
Highlights
Caudal epidural steroid injections (CESIs) are an effective treatment for pain
As spinal discs are located near the ventral epidural space, ventral spread during CESI could be logically presumed to be an effective treatment in patients who have a herniated intervertebral disc (HIVD) or discogenic pain [2, 5, 6]
There were 229 CESIs performed in this study; 19 cases (8.3%) were excluded because they received an intravascular injection during the CESI
Summary
Caudal epidural steroid injections (CESIs) are an effective treatment for pain. If the injection spreads in a specific pattern depending on the needle position or bevel direction, it would be possible to inject the agent into a specific and desired area. In the 210 CESIs performed, the needle tip position and bevel direction did not influence the epidural spreading patterns at L4-5 and L5-S1 disc levels. Neither the needle tip position nor the bevel direction affected the epidural drug spreading pattern during CESI. Some physicians, including the authors of this paper, tend to position the needle tip at the patient’s painful side (right or left) to ensure an effective drug spread to the target area of the pain. Using this method, physicians expect that most of the injected drug will spread to the painful side. Gupta et al [7] and Ackerman III and Ahmad [8] reported that ventral spread of epidurography was associated with improvements in the pain score after interlaminar, transforaminal, and/or caudal epidural injections
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