Ultrasound-guided fluoroscopic-verified lumbar transforaminal epidural injection: A clinical evaluation of technique

Abstract

Background: Fluoroscope guidance method is the gold standard for performing lumbar transforaminal epidural steroid injections (TFESIs), but it is not devoid of adverse effects such as exposure to radiation and need to wear heavy lead aprons. Ultrasound (US)-guided techniques are being evaluated recently but methodological acceptability and reproducibility remain unknown. So after reviewing literatures, studing the us scan of lumber region, we have performed these injection safely and methodologial manner and describing in this study. Duration of Study: The duration of this study was six months, from May 01, 2016, to November 31, 2016. Study Design: This was a prospective, open-label, clinical, pilot study. Materials and Methods: A total of twenty patients with low back pain and radiculopathy were enrolled in this study. A US-guided novel technique was used to perform TFESI. A needle was placed under the guidance of US, and then verified with fluoroscope for dye spread. Then, predecided mixture of drugs were injected. Patients were monitored for number of attempts for localization of transforaminal space, number of adjustment, time taken for needle insertion in transforaminal space, radiation dosage, if the cortex of bone touched by the needle, and whether any complication occurred. Results: The number of attempts for localization of transforaminal space in 85% was one and two in 15% of the patients, number of adjustment per attempt was 5.3, and the average time taken for TFESI in patients in one-attempt group was 973 ± 93 s and 1506 ± 65 s in two-attempt group. Average exposure time of fluoroscope per person was 17.5 ± 2.5 s only. Bone was contacted in 75% of cases and no complications were noted. Conclusion: Lumbar TFESI can be safely and effectively performed under US guidance but fluoroscopic confirmation is required to rule out intravascular and intrathecal spread of the contrast at this stage. However, US guidance has reduced radiation exposure to significant level in this study.