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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 26:502-505, March 2005
© 2005 American Society of Neuroradiology

Technical Note
SPINE

Incorrect Needle Position during Lumbar Epidural Steroid Administration: Inaccuracy of Loss of Air Pressure Resistance and Requirement of Fluoroscopy and Epidurography during Needle Insertion

Walter S. Bartynski^a, Stephen Z. Grahovac^a,b and William E. Rothfus^a

^a Department of Radiology, Division of Neuroradiology, University of Pittsburgh Medical Center, Pittsburgh, PA,
^b Department of Radiology, Christiana Hospital, Newark, DE

Address correspondence to Walter S. Bartynski, MD, Department of Radiology, Division of Neuroradiology, University of Pittsburgh Medical Center, Presbyterian University Hospital, 200 Lothrop Street, D-132, Pittsburgh, PA 15213. E-mail: bartynskiws{at}upmc.edu

Summary: Loss of air pressure resistance leads to a high rate (25.7%) of inaccurate needle-tip placement in the posterior soft tissues of the back during lumbar epidural steroid administration employing a 20-gauge Tuohy needle. Imaging and epidurogram are essential for confident identification of the lumbar epidural space to enable accurate location of steroid administration. Studies assessing efficacy of lumbar epidural steroid injection and individual patient treatments should ensure location of administration with epidurogram to enhance the validity of results.

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