Relationship between needle depth for lumbar transforaminal epidural injection and patients’ height and weight using magnetic resonance imaging
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background: Optimal needle depth in transforaminal epidural injection (TFEI) is determined by body measurements and is influenced by the needle entry angle. Physician can choose the appropriate needle length and perform the procedure more effectively if depth is predicted in advance. Methods: This retrospective study included patients with lumbosacral pain from a single university hospital. The skin depth from the target point was measured using magnetic resonance imaging transverse images. The depth was measured bilaterally for L4 and L5 TFEIs at 15°, 20°, and 25° oblique angles from the spinous process. Results: A total of 4,632 measurements of 386 patients were included. The lengths of the left and right TFEI at the same level and oblique angle were assessed, and no statistical differences were identified. Therefore, linear regression analysis was performed for bilateral L4 and L5 TFEIs. The R-squared values of height and weight combined were higher than the height, weight, and body mass index (BMI). The following equation was established: Depth (mm) = a – b (height, cm) + c (weight, kg). Based on the equation, maximal BMI capable with a 23G, 3.5-inch, Quincke-type point spinal needle was presented for three different angles (15°, 20°, and 25°) at lumbar levels L4 and L5. Conclusions: The maximal BMI that derived from the formulated equation is listed on the table, which can help in preparations for morbid obesity. If a patient has bigger BMI than the one in the table, the clinician should prepare longer needle than the usual spinal needle.
Abstract
Background: Optimal needle depth in transforaminal epidural injection (TFEI) is determined by body measurements and is influenced by the needle entry angle. Physician can choose the appropriate needle length and perform the procedure more effectively if depth is predicted in advance. Methods: This retrospective study included patients with lumbosacral pain from a single university hospital. The skin depth from the target point was measured using magnetic resonance imaging transverse images. The depth was measured bilaterally for L4 and L5 TFEIs at 15°, 20°, and 25° oblique angles from the spinous process. Results: A total of 4,632 measurements of 386 patients were included. The lengths of the left and right TFEI at the same level and oblique angle were assessed, and no statistical differences were identified. Therefore, linear regression analysis was performed for bilateral L4 and L5 TFEIs. The R-squared values of height and weight combined were higher than the height, weight, and body mass index (BMI). The following equation was established: Depth (mm) = a – b (height, cm) + c (weight, kg). Based on the equation, maximal BMI capable with a 23G, 3.5-inch, Quincke-type point spinal needle was presented for three different angles (15°, 20°, and 25°) at lumbar levels L4 and L5. Conclusions: The maximal BMI that derived from the formulated equation is listed on the table, which can help in preparations for morbid obesity. If a patient has bigger BMI than the one in the table, the clinician should prepare longer needle than the usual spinal needle.
참고문헌 (32)
- Lee Kyoung Kim, "Analysis of Influencing Factors to Depth of Epidural Space for Lumbar Transforaminal Epidural Block in Korean", The Korean Journal of Pain, 24(4), pp.216~220 (2011), 대한통증학회
- Manchikanti L, "Growth of spinal interventional pain management techniques : analysis of utilization trends and Medicare expenditures 2000 to 2008", Spine (Phila Pa 1976), 38, pp.157~168 (2013)
- Savas Sencan, "Comparison of treatment outcomes in lumbar central stenosis patients treated with epidural steroid injections: interlaminar versus bilateral transforaminal approach", The Korean Journal of Pain, 33(3), pp.226~233 (2020), 대한통증학회[DOI]
- Helm S, "Transforaminal epidural steroid injections : a systematic review and meta-analysis of efficacy and safety", Pain Physician, 24(S1), pp.S209~S232 (2021)
- Bensler S, "Particulate versus non-particulate corticosteroids for transforaminal nerve root blocks : comparison of outcomes in 494 patients with lumbar radiculopathy", Eur Radiol, 28, pp.946~952 (2018)
- Vad VB, "Transforaminal epidural steroid injections in lumbosacral radiculopathy : a prospective randomized study", Spine (Phila Pa 1976), 27, pp.11~16 (2002)
- Nicholas K. Donohue, "Comparing pain relief and functional improvement between methylprednisolone and dexamethasone lumbosacral transforaminal epidural steroid injections: a self-controlled study", The Korean Journal of Pain, 33(2), pp.192~198 (2020), 대한통증학회[DOI]
- Rezende R, "Comparison of the efficacy of transforaminal and interlaminar radicular block techniques for treating lumbar disk hernia", Rev Bras Ortop, 50, pp.220~225 (2015)
- Chang-Chien GC, "Transforaminal versus interlaminar approaches to epidural steroid injections : a systematic review of comparative studies for lumbosacral radicular pain", Pain Physician, 17, pp.E509~E524 (2014)
- 박준모, "Analysis of dispersion of lumbar interlaminar epidural injectates", Korean Journal of Anesthesiology, 65(6), pp.139~140 (2013), 대한마취통증의학회
- Lutz GE, "Fluoroscopic transforaminal lumbar epidural steroids : an outcome study", Arch Phys Med Rehabil, 79, pp.1362~1366 (1998)
- 정지선, "Fluoroscopic analysis of lumbar epidural contrast spread after retrograde interlaminar ventral epidural injection (RIVEI)", Korean Journal of Anesthesiology, 65(5), pp.431~437 (2013), 대한마취통증의학회
- Schaufele MK, "Interlaminar versus transforaminal epidural injections for the treatment of symptomatic lumbar intervertebral disc herniations", Pain Physician, 9, pp.361~366 (2006)
- 김미운, "성인에서 자기 공명영상(MRI)을 이용하여 측정한요추 경막외강의 깊이와 비만도(BMI)와의 상관관계", Korean Journal of Anesthesiology, 47(1), pp.34~37 (2004), 대한마취통증의학회
- Ra IH, "Optimal angle of needle insertion for fluoroscopy-guided transforaminal epidural injection of L5", Pain Pract, 15, pp.393~399 (2015)
- 홍지희, "요척주관 협착증 혹은 추간판 탈출증 환자에서 실시한 경추간공 경막외 스테로이드 주입의 결과에 관한 분석", The Korean Journal of Pain, 21(1), pp.38~43 (2008), 대한통증학회
- Goodman BS, "Complications and pitfalls of lumbar interlaminar and transforaminal epidural injections", Curr Rev Musculoskelet Med, 1, pp.212~222 (2008)
- Chang A, "Complications associated with lumbar transforaminal epidural steroid injections", Curr Pain Headache Rep, 24, pp.67~ (2020)
- Husseini JS, "Fluoroscopically guided lumbar spine interlaminar and transforaminal epidural injections : inadvertent intravascular injection", Acta Radiol, 61, pp.1534~1540 (2020)
- Algrain H, "Cervical epidural depth : correlation between cervical MRI measurements of the skin-to-cervical epidural space and the actual needle depth during interlaminar cervical epidural injections", Pain Med, 19, pp.1015~1022 (2018)
- Galbraith AS, "Examining the association of body mass index and the depth of epidural space, radiation dose exposure and fluoroscopic screening time during transforaminal nerve block injection : a retrospective cohort study", Ir J Med Sci, 188, pp.295~302 (2019)
- Jones JH, "Assessing the agreement between radiologic and clinical measurements of lumbar and cervical epidural depths in patients undergoing prone interlaminar epidural steroid injection", Anesth Analg, 124, pp.1678~1685 (2017)
- 홍지희, "Does spinal stenosis correlate with MRI findings and pain, psychologic factor and quality of life?", Korean Journal of Anesthesiology, 68(5), pp.481~487 (2015), 대한마취통증의학회
- Brunner P, "Approaches in injections for radicular pain : the transforaminal, epidural and transfacet approaches", Diagn Interv Imaging, 93, pp.711~722 (2012)
- Bhatia A, "Transforaminal epidural steroid injections for treating lumbosacral radicular pain from herniated intervertebral discs : a systematic review and meta-analysis", Anesth Analg, 122, pp.857~870 (2016)
- Botwin KP, "Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis : an outcome study", Am J Phys Med Rehabil, 81, pp.898~905 (2002)
- Botwin K, "Epidurography contrast patterns with fluoroscopic guided lumbar transforaminal epidural injections : a prospective evaluation", Pain Physician, 7, pp.211~215 (2004)
- Lee JH, "Comparison of clinical efficacy between transforaminal and interlaminar epidural injections in lumbosacral disc herniation : a systematic review and meta-analysis", Pain Physician, 21, pp.433~448 (2018)
- Carnie J, "Prediction by computerised tomography of distance from skin to epidural space during thoracic epidural insertion", Anaesthesia, 57, pp.701~704 (2002)
- Brummett CM, "A prospective, observational study of the relationship between body mass index and depth of the epidural space during lumbar transforaminal epidural steroid injection", Reg Anesth Pain Med, 34, pp.100~105 (2009)
- Yingsakmongkol W, "How prone position affects the anatomy of lumbar nerve roots and psoas morphology for prone transpsoas lumbar interbody fusion", World Neurosurg, 160, pp.e628~e635 (2022)
- Amaral R, "The effect of patient position on psoas morphology and in lumbar lordosis", World Neurosurg, 153, pp.e131~e140 (2021)