Correct placement of epidural steroid injections

Fluoroscopic guidance and contrast administration

D. L. Renfrew, Timothy Eisdell Moore, M. H. Kathol, G. Y. El-Khoury, J. H. Lemke, C. W. Walker

Research output: Contribution to journalArticle

214 Citations (Scopus)

Abstract

We prospectively evaluated 316 caudal-approach epidural steroid injections given by staff radiologists and residents in our department over a 1-year period. Needle placement was checked with fluoroscopy and corrected if necessary. When the needle tip was within the sacral canal, nonionic contrast material was injected. If epidural contrast was not observed, the needle tip was repositioned. Of 111 procedures performed by physicians who had given fewer than 10 epidural steroid injections, 53 (47.7%) resulted in correct nonfluoroscopically directed placement of the needle. For physicians who had performed between 10 and 50 such procedures, 62 (53.4%) of 116 had correct nonfluoroscopically directed placement. For staff physicians, 55 (61.7%) of 89 placements were correct. Even when the sacral hiatus was easily palpated and a staff physician was confident that he or she was within the epidural space, fluoroscopy revealed incorrect placement 14.2% of the time (seven of 49 procedures). In addition, when the needle was positioned within the sacral canal and no blood was evident on Valsalva maneuver or aspiration, the injection was venous in 29 of 316 procedures (9.2%). The presence of blood on the needle stylus was not a reliable indicator of venous placement of the needle. Our findings indicate that fluoroscopy is essential for correct placement of epidural steroid injection. Contrast administration is necessary to avoid venous injection of steroids.

Original languageEnglish (US)
Pages (from-to)1003-1007
Number of pages5
JournalAmerican Journal of Neuroradiology
Volume12
Issue number5
StatePublished - Jan 1 1991

Fingerprint

Epidural Injections
Needles
Steroids
Fluoroscopy
Physicians
Valsalva Maneuver
Epidural Space
Injections
Contrast Media

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Renfrew, D. L., Moore, T. E., Kathol, M. H., El-Khoury, G. Y., Lemke, J. H., & Walker, C. W. (1991). Correct placement of epidural steroid injections: Fluoroscopic guidance and contrast administration. American Journal of Neuroradiology, 12(5), 1003-1007.

Correct placement of epidural steroid injections : Fluoroscopic guidance and contrast administration. / Renfrew, D. L.; Moore, Timothy Eisdell; Kathol, M. H.; El-Khoury, G. Y.; Lemke, J. H.; Walker, C. W.

In: American Journal of Neuroradiology, Vol. 12, No. 5, 01.01.1991, p. 1003-1007.

Research output: Contribution to journalArticle

Renfrew, DL, Moore, TE, Kathol, MH, El-Khoury, GY, Lemke, JH & Walker, CW 1991, 'Correct placement of epidural steroid injections: Fluoroscopic guidance and contrast administration', American Journal of Neuroradiology, vol. 12, no. 5, pp. 1003-1007.
Renfrew, D. L. ; Moore, Timothy Eisdell ; Kathol, M. H. ; El-Khoury, G. Y. ; Lemke, J. H. ; Walker, C. W. / Correct placement of epidural steroid injections : Fluoroscopic guidance and contrast administration. In: American Journal of Neuroradiology. 1991 ; Vol. 12, No. 5. pp. 1003-1007.
@article{3b5cd1b736584d559be7daaa3bb70793,
title = "Correct placement of epidural steroid injections: Fluoroscopic guidance and contrast administration",
abstract = "We prospectively evaluated 316 caudal-approach epidural steroid injections given by staff radiologists and residents in our department over a 1-year period. Needle placement was checked with fluoroscopy and corrected if necessary. When the needle tip was within the sacral canal, nonionic contrast material was injected. If epidural contrast was not observed, the needle tip was repositioned. Of 111 procedures performed by physicians who had given fewer than 10 epidural steroid injections, 53 (47.7{\%}) resulted in correct nonfluoroscopically directed placement of the needle. For physicians who had performed between 10 and 50 such procedures, 62 (53.4{\%}) of 116 had correct nonfluoroscopically directed placement. For staff physicians, 55 (61.7{\%}) of 89 placements were correct. Even when the sacral hiatus was easily palpated and a staff physician was confident that he or she was within the epidural space, fluoroscopy revealed incorrect placement 14.2{\%} of the time (seven of 49 procedures). In addition, when the needle was positioned within the sacral canal and no blood was evident on Valsalva maneuver or aspiration, the injection was venous in 29 of 316 procedures (9.2{\%}). The presence of blood on the needle stylus was not a reliable indicator of venous placement of the needle. Our findings indicate that fluoroscopy is essential for correct placement of epidural steroid injection. Contrast administration is necessary to avoid venous injection of steroids.",
author = "Renfrew, {D. L.} and Moore, {Timothy Eisdell} and Kathol, {M. H.} and El-Khoury, {G. Y.} and Lemke, {J. H.} and Walker, {C. W.}",
year = "1991",
month = "1",
day = "1",
language = "English (US)",
volume = "12",
pages = "1003--1007",
journal = "American Journal of Neuroradiology",
issn = "0195-6108",
publisher = "American Society of Neuroradiology",
number = "5",

}

TY - JOUR

T1 - Correct placement of epidural steroid injections

T2 - Fluoroscopic guidance and contrast administration

AU - Renfrew, D. L.

AU - Moore, Timothy Eisdell

AU - Kathol, M. H.

AU - El-Khoury, G. Y.

AU - Lemke, J. H.

AU - Walker, C. W.

PY - 1991/1/1

Y1 - 1991/1/1

N2 - We prospectively evaluated 316 caudal-approach epidural steroid injections given by staff radiologists and residents in our department over a 1-year period. Needle placement was checked with fluoroscopy and corrected if necessary. When the needle tip was within the sacral canal, nonionic contrast material was injected. If epidural contrast was not observed, the needle tip was repositioned. Of 111 procedures performed by physicians who had given fewer than 10 epidural steroid injections, 53 (47.7%) resulted in correct nonfluoroscopically directed placement of the needle. For physicians who had performed between 10 and 50 such procedures, 62 (53.4%) of 116 had correct nonfluoroscopically directed placement. For staff physicians, 55 (61.7%) of 89 placements were correct. Even when the sacral hiatus was easily palpated and a staff physician was confident that he or she was within the epidural space, fluoroscopy revealed incorrect placement 14.2% of the time (seven of 49 procedures). In addition, when the needle was positioned within the sacral canal and no blood was evident on Valsalva maneuver or aspiration, the injection was venous in 29 of 316 procedures (9.2%). The presence of blood on the needle stylus was not a reliable indicator of venous placement of the needle. Our findings indicate that fluoroscopy is essential for correct placement of epidural steroid injection. Contrast administration is necessary to avoid venous injection of steroids.

AB - We prospectively evaluated 316 caudal-approach epidural steroid injections given by staff radiologists and residents in our department over a 1-year period. Needle placement was checked with fluoroscopy and corrected if necessary. When the needle tip was within the sacral canal, nonionic contrast material was injected. If epidural contrast was not observed, the needle tip was repositioned. Of 111 procedures performed by physicians who had given fewer than 10 epidural steroid injections, 53 (47.7%) resulted in correct nonfluoroscopically directed placement of the needle. For physicians who had performed between 10 and 50 such procedures, 62 (53.4%) of 116 had correct nonfluoroscopically directed placement. For staff physicians, 55 (61.7%) of 89 placements were correct. Even when the sacral hiatus was easily palpated and a staff physician was confident that he or she was within the epidural space, fluoroscopy revealed incorrect placement 14.2% of the time (seven of 49 procedures). In addition, when the needle was positioned within the sacral canal and no blood was evident on Valsalva maneuver or aspiration, the injection was venous in 29 of 316 procedures (9.2%). The presence of blood on the needle stylus was not a reliable indicator of venous placement of the needle. Our findings indicate that fluoroscopy is essential for correct placement of epidural steroid injection. Contrast administration is necessary to avoid venous injection of steroids.

UR - http://www.scopus.com/inward/record.url?scp=0026052819&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026052819&partnerID=8YFLogxK

M3 - Article

VL - 12

SP - 1003

EP - 1007

JO - American Journal of Neuroradiology

JF - American Journal of Neuroradiology

SN - 0195-6108

IS - 5

ER -