Retrospective lumbosacral CT analysis and prospective observational study of the ipsilateral tunnel view technique for fluoroscopy-guided selective S1 transforaminal epidural injection.

Abstract

The purpose of this study was to retrospectively observe the anatomic relationship between dorsal S1 foramen (DS1F) and ventral S1 foramen (VS1F) through computed tomography (CT) analysis and to prospectively determine the optimal angle of ipsilateral tunnel view technique for performing S1 transforaminal epidural steroid injection (S1-TFESI). The axial lumbosacral CTs taken between in 208 consecutive patients and the following measurements were obtained on both sides: (1) the α-angle was defined as an angle between a sagittal line passing through the center of the sacrum and an imaginary line passing through the center of DS1F, (2) the largest diameter of DS1F and VS1F. The fluoroscopy was adjusted to show the largest L5/S1 intervertebral disc space, which was defined as the cephalad angle, and tilted to the ipsilateral oblique side until the entrance of DS1F had a well-defined, round shape, which defined as the β-angle in 40 humans. CT measurements showed that the α-angle was 26.3±3.3 degrees (15-38 degrees) and the diameter of DS1F was 7.1±0.7mm (4-10.9mm), which was significantly smaller than the diameter of VS1F, 10.1±1.0mm (7.2-13.8mm). The β-angle was 24±4.6degrees, which was not much different from the α-angle and the cephalad angle was 23±4.6degrees. The success rate of S1-TFESI was 100% and there were no procedure-related complications. The entrance of DS1F is easily identified with an ipsilateral 25 degrees-tunnel view technique while performing S1-TFESI, and it is a clinically applicable approach.