PM&R
Volume 2, Issue 7 , Pages 625-635 , July 2010

Injectate Volumes Needed to Reach Specific Landmarks in Lumbar Transforaminal Epidural Injections

  • Michael B. Furman, MD, MS

      Affiliations

    • Orthopaedic and Spine Specialists, 1855 Powder Mill Road, York, PA 17403†
    • Corresponding Author InformationAddress correspondence to: M.B.F.
    • ,
  • Ariz R. Mehta, MD

      Affiliations

    • Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School, New York, NY‡
    • ,
  • Ruby E. Kim, MD

      Affiliations

    • Orthopaedic and Spine Specialists, York, PA§
    • ,
  • Jeremy I. Simon, MD

      Affiliations

    • Rothman Institute, Philadelphia, PA∥
    • ,
  • Rikin Patel, DO

      Affiliations

    • Mercerbucks Orthopedics, Hamilton, NJ
    • ,
  • Thomas S. Lee, MD

      Affiliations

    • Physical Medicine and Pain Management Associates, Annapolis, MD⁎⁎
    • ,
  • Ryan S. Reeves, MD

      Affiliations

    • Spine Team Texas, Southlake, TX††

Received 1 October 2009 ,Accepted 18 April 2010.

References 

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  2. on behalf of the Standards Committee of the International Spine Intervention Society In:  Bogduk N editors. Practice Guidelines Spinal Diagnostic Treatment and Procedures. 1st ed.. San Rafael, CA: International Spine Intervention Society; 2004;
  3. Ohtori S, Takahashi K, Moriya H, et al. TNF alpha and TNF alpha receptor type I upregulation in glia and neurons after peripheral nerve injury. Spine. 2004;29:1082–1088
  4. Kelsey JL, White AA. Epidemiology and impact of low-back pain. Spine. 1980;5:133–142
  5. DePalma MJ, Bhargava A, Slipman CW. A critical appraisal of the evidence for selective nerve root injection in the treatment of lumbosacral radiculopathy. Arch Phys Med Rehabil. 2005;86:1477–1483
  6. Botwin KP, Gruber RD, Bouchlas CG, et al. Fluoroscopically guided lumbar transforaminal epidural steroid injections in degenerative lumbar stenosis. Am J Phys Med Rehabil. 2002;81:898–905
  7. Vad VB, Bhat AL, Lutz GE, Cammisa F. Transforaminal epidural steroid injections in lumbosacral radiculopathy. Spine. 2002;27:11–16
  8. Karppinen J, Malmivaara A, Kurunlahti M, et al. Periradicular infiltration for sciatica. Spine. 2001;26:1059–1067
  9. Lutz GE, Vad VB, Wisneski RJ. Fluoroscopic transforaminal lumbar epidural steroids: An outcome study. Arch Phys Med Rehabil. 1998;79:1362–1366
  10. Aoki Y, Ohtori S, Takahashi K. Innervation of the lumbar intervertebral disc by nerve growth factor-dependent neurons related to inflammatory pain. Spine. 2004;29:1077–1081
  11. Jeong HS, Lee JW, Kim SH, Myung JS, Kim JH, Kang HS. Effectiveness of transforaminal epidural steroid injection by using a preganglionic approach: A prospective randomized controlled study. Radiology. 2007;245:584–590
  12. Sandberg DI, Lavyne MH. Symptomatic spinal epidural lipomatosis after local epidural corticosteroid injections: a case report. Neurosurgery. 1999;45:162–165
  13. Fardon DF, Milette PC. Nomenclature and classification of lumbar disc pathology. Spine. 2001;26:E92–E1135
  14. Jasper JF. Lumbar retrodiscal transforaminal injection. Pain Physician. 2007;10:501–510
  15. Furman MB, Lee TS, Mehta A, Simon JI, Cano WG. Contrast flow selectivity during transforaminal lumbosacral epidural steroid injections. Pain Physician. 2008;11:855–861
  16. Whitlock EL, Bridwell KH, Gilula LA. Influence of needle tip position on injectate spread in 406 interlaminar lumbar epidural steroid injections. Radiology. 2007;3:804–811
  17. Blomberg R. The dorsomedian connective tissue band in the lumbar epidural space of humans: an anatomical study using epiduroscopy in autopsy cases. Anesth Analg. 1986;65:747–752
  18. Laker SR, Standaert CJ. Contrast flow patterns observed during epidural steroid injections. Spineline. 2009;28–31
  19. Botwin KP, Natalicchio J, Hanna A. Fluoroscopic guided lumbar interlaminar epidural injections: a prospective evaluation of epidurography contrast patterns and anatomical review of the epidural space. Pain Physician. 2004;7:77–80
  20. Fenton DS, Czervionke LF. Image-Guided Spine Intervention. Philadelphia, PA: Saunders; 2003;74
  21. Vassiliev D. Spread of contrast during L4 and L5 nerve root infiltration under fluoroscopic guidance. Pain Physician. 2007;10:461–466
  22. Bogduk N, Aprill C, Derby R. Selective nerve root blocks. In:  Wilson DJ editors. Interventional Radiology of the Musculoskeletal System. London: Edward Arnold; 1995;p. 121–132
  23. Bogduk N, Aprill C, Derby R. Epidural steroid injections. In:  White AH editors. Spine Care, Volume One: Diagnosis and Conservative Treatment. St. Louis: Mosby; 1995;p. 322–343
  24. ISOVUE 320, manufacturer Bracco Diagnostics, Princeton, NJ.
  25. 1% Lidocaine HCL, manufacturer Hospira, Inc., Lake Forest, IL.

 This CME activity is designated for 1.0 AMA PRA Category 1 Credit™ and can be completed online at me.aapmr.org. Log on to www.me.aapmr.org, go to Lifelong Learning (CME) and select Journal-based CME from the drop down menu. This activity is FREE to AAPM&R members and $25 for non-members.

PII: S1934-1482(10)00343-6

doi: 10.1016/j.pmrj.2010.04.023

PM&R
Volume 2, Issue 7 , Pages 625-635 , July 2010

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