PM&R
Volume 1, Issue 7 , Pages 636-642, July 2009

The Rate of Detection of Intravascular Injection in Cervical Transforaminal Epidural Steroid Injections With and Without Digital Subtraction Angiography

  • James P. McLean, MD

      Affiliations

    • Spine Center, Kansas University Medical Center; Kansas City, KS†
    • Deceased.
    • ,
  • James D. Sigler, MD

      Affiliations

    • Department of Physical Medicine & Rehabilitation, Kansas University Medical Center, Kansas City, KS‡
    • ,
  • Christopher T. Plastaras, MD

      Affiliations

    • Department of Rehabilitation Medicine, University of Pennsylvania, Philadelphia, PA§
    • ,
  • Cynthia Wilson Garvan, PhD

      Affiliations

    • College of Education, University of Florida; Gainesville, FL
    • ,
  • Joshua D. Rittenberg, MD

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine; Rehabilitation Institute of Chicago, 1030 N. Clark Street, Suite 500, Chicago, IL 60610∥
    • Corresponding Author InformationAddress correspondence to: J.D.R.

Received 30 October 2008; accepted 29 March 2009.

Objective

To determine whether digital subtraction angiography (DSA) combined with real-time fluoroscopic imaging improves the detection rate of intravascular injection during cervical transforaminal epidural steroid injections (CTFESIs).

Design

Retrospective analysis.

Setting

Outpatient surgery center.

Participants

A total of 134 subjects with cervical radicular pain who had CTFESIs performed by a single physician between June 9, 2004, and April 23, 2007.

Interventions

One hundred seventy-seven CTFESIs performed at one or more cervical spinal levels either unilaterally or bilaterally. Procedures performed before September 12, 2005, used fluoroscopic guidance with contrast injection and live imaging to identify intravascular injection. All procedures performed after September 12, 2005, also included DSA.

Main Outcome Measures

Intravascular injection detected during CTFESIs with and without DSA.

Results

Intravascular injection was detected in 17.9% of CTFESIs performed without DSA. By adding DSA technology to the real-time fluoroscopic imaging procedure, the detection of vascular injection nearly doubled to 32.8%, which was statistically significant (P = .0471).

Conclusions

The use of DSA improves the detection rate of intravascular injection during CTFESIs.

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  • † Disclosure: nothing to disclose
  • ‡ Disclosure: nothing to disclose
  • § Disclosure: nothing to disclose
  •  Disclosure: nothing to disclose
  • ∥ Disclosure: nothing to disclose

 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org

PII: S1934-1482(09)00384-0

doi:10.1016/j.pmrj.2009.03.017

PM&R
Volume 1, Issue 7 , Pages 636-642, July 2009

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