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Logo of armAnnals of Rehabilitation MedicineAims and ScopeInstructions for AuthorsE-SubmissionThis article
 
Ann Rehabil Med. Aug 2012; 36(4): 474–479.
Published online Aug 27, 2012. doi:  10.5535/arm.2012.36.4.474
PMCID: PMC3438413
Contrast Spreading Patterns in Retrodiscal Transforaminal Epidural Steroid Injection
Chul Kim, M.D., Ph.D., Hee Eun Choi, M.D., and Seonghoon Kang, M.D.corresponding author
Department of Physical Medicine and Rehabilitation, Sanggye Paik Hospital, Seoul 139-707, Korea.
corresponding authorCorresponding author.
Corresponding author: Seonghoon Kang. Department of Physical Medicine and Rehabilitation, Sanggye Paik Hospital, 761-1, Sanggye 7 dong, Nowon-gu, Seoul 139-707, Korea. Tel: +82-2-950-1390, Fax: +82-2-935-3076, shgang777/at/hanmail.net, ckim/at/paik.ac.kr
Received December 16, 2011; Accepted June 25, 2012.
Abstract
Objective
To observe the contrast spreading patterns in the retrodiscal (RD) approach for transforaminal epidural steroid injections and their effect on pain reduction.
Method
Patients with L5 radiculopathy who were scheduled to receive lumbar TF-EPB were consecutively included. We randomly divided them into the L4-5 RD and L5-S1 RD groups and administered 1 cc of contrast dye into epidural space. We observed the shape and the location of contrast dye on the anterior-posterior and lateral views. We injected 1 cc of 0.5% lidocaine mixed with 20 mg of triamcinolone, and checked the pain intensity before and two weeks after the procedure by using visual analogue scale (VAS).
Results
In the L4-5 RD group (n=30), contrast spread over the L4 nerve root in 27 cases and the L4 and L5 nerve roots in 3 cases. In the L5-S1 RD group (n=33), contrast spread over the L5 nerve root in 20 cases, the S1 nerve root in 3 cases, and the L5 and the S1 nerve roots in 10 cases. The contrast spreading patterns could be divided into 4 patterns: the proximal root in 40 cases, the distal root in 19 cases, the anterior epidural space in 3 cases and an undefined pattern in 1 case.
Conclusion
In RD lumbar TF-EPB, the contrast dye mostly went into the cephalic root and about 60% spread over the proximal nerve root. There was less pain reduction when the contrast dye spread over the distal nerve root.
Keywords: Contrast dye, Epidural block, Retrodiscal, Transforaminal
Articles from Annals of Rehabilitation Medicine are provided here courtesy of
Korean Academy of Rehabilitation Medicine