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. Bartynskia,
Stephen Z. Grahovaca,b and
William E. Rothfusa
a Department of Radiology, Division of Neuroradiology, University of Pittsburgh Medical Center, Pittsburgh, PA,
b Department of Radiology, Christiana Hospital, Newark, DE
View larger version (99K):
[in a new window]
|
FIG 1. Lateral fluoroscopic images of a 52-year-old man with back pain and leg pain during LESI procedure.
A, Contrast medium injected at loss of resistance is seen overlying the deep paraspinal region just posterior to the ligamentum flavum and spinal canal (arrows).
B, The needle was advanced and the epidural space is correctly engaged and the correct needle-tip location is confirmed with epidurogram (white arrow). Initial injection is also visible (black arrowhead).
| |
View larger version (148K):
[in a new window]
|
FIG 2. Lateral fluoroscopic images of a 23-year-old man with back pain during LESI procedure. Contrast medium injected at point of loss of resistance is seen overlying the spinous process still within the midback soft tissues (arrow). The needle tip was subsequently advanced to the posterior epidural space and confirmed with epidurogram.
| |
View larger version (106K):
[in a new window]
|
FIG 3. A and B, Lateral and anteroposterior fluoroscopic images of a 56 year-old-man with back and leg pain during LESI procedure demonstrates proper position of the needle tip after initial loss of resistance in the posterior epidural space in the lateral (arrow) and anteroposterior (curved arrow) projections.
| |
View larger version (177K):
[in a new window]
|
FIG 4. Prone CT image in a 36-year-old woman with radiculopathy undergoing epidural steroid injection with CT guidance demonstrates extensive fat in the posterior paraspinal soft tissues adjacent to the ligamentum flavum (arrow).
| |
