Prediction of successful caudal epidural injection using color Doppler ultrasonography in the paramedian sagittal oblique view of the lumbosacral spine
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Background: Ultrasound-guided caudal epidural injection (CEI) is limited in that it cannot confirm drug distribution at the target site without fluoroscopy. We hypothesized that visualization of solution flow through the inter-laminar space of the lumbosacral spine using color Doppler ultrasound alone would allow for confirmation of drug distribution. Therefore, we aimed to prospectively evaluate the usefulness of this method by comparing the color Doppler image in the paramedian sagittal oblique view of the lumbosacral spine (LS-PSOV) with the distribution of the contrast medium observed during fluoroscopy. Methods: Sixty-five patients received a 10-mL CEI of solution containing contrast medium under ultrasound guidance. During injection, flow was observed in the LSPSOV using color Doppler ultrasonography, following which it was confirmed using fluoroscopy. The presence of contrast image at L5-S1 on fluoroscopy was defined as “successful CEI.” We then calculated prediction accuracy for successful CEI using color Doppler ultrasonography in the LS-PSOV. We also investigated the correlation between the distribution levels measured via color Doppler and fluoroscopy. Results: Prediction accuracy with color Doppler ultrasonography was 96.9%. The sensitivity, specificity, positive predictive value, and negative predictive value were 96.7%, 100%, 100%, and 60.0%, respectively. In 52 of 65 patients (80%), the highest level at which contrast image was observed was the same for both color Doppler ultrasonography and fluoroscopy. Conclusions: Our findings demonstrate that color Doppler ultrasonography in the LS-PSOV is a new method for determining whether a drug solution reaches the lumbosacral region (i.e. , the main target level) without the need for fluoroscopy.
Abstract
Background: Ultrasound-guided caudal epidural injection (CEI) is limited in that it cannot confirm drug distribution at the target site without fluoroscopy. We hypothesized that visualization of solution flow through the inter-laminar space of the lumbosacral spine using color Doppler ultrasound alone would allow for confirmation of drug distribution. Therefore, we aimed to prospectively evaluate the usefulness of this method by comparing the color Doppler image in the paramedian sagittal oblique view of the lumbosacral spine (LS-PSOV) with the distribution of the contrast medium observed during fluoroscopy. Methods: Sixty-five patients received a 10-mL CEI of solution containing contrast medium under ultrasound guidance. During injection, flow was observed in the LSPSOV using color Doppler ultrasonography, following which it was confirmed using fluoroscopy. The presence of contrast image at L5-S1 on fluoroscopy was defined as “successful CEI.” We then calculated prediction accuracy for successful CEI using color Doppler ultrasonography in the LS-PSOV. We also investigated the correlation between the distribution levels measured via color Doppler and fluoroscopy. Results: Prediction accuracy with color Doppler ultrasonography was 96.9%. The sensitivity, specificity, positive predictive value, and negative predictive value were 96.7%, 100%, 100%, and 60.0%, respectively. In 52 of 65 patients (80%), the highest level at which contrast image was observed was the same for both color Doppler ultrasonography and fluoroscopy. Conclusions: Our findings demonstrate that color Doppler ultrasonography in the LS-PSOV is a new method for determining whether a drug solution reaches the lumbosacral region (i.e. , the main target level) without the need for fluoroscopy.
참고문헌 (25)
- Oliveira CB, "Epidural corticosteroid injections for lumbosacral radicular pain", Cochrane Database Syst Rev, 4, pp.CD013577~ (2020)
- Oliveira CB, "Epidural corticosteroid injections for sciatica : an abridged Cochrane systematic review and meta-analysis", Spine (Phila Pa 1976), 45, pp.E1405~E1415 (2020)
- Yang S, "Epidural steroid injection versus conservative treatment for patients with lumbosacral radicular pain : a meta-analysis of randomized controlled trials", Medicine (Baltimore), 99, pp.e21283~ (2020)
- McLain RF, "Epidural steroid therapy for back and leg pain : mechanisms of action and efficacy", Spine J, 5, pp.191~201 (2005)
- Stitz MY, "Accuracy of blind versus fluoroscopically guided caudal epidural injection", Spine (Phila Pa 1976), 24, pp.1371~1376 (1999)
- Barham G, "Caudal epidurals : the accuracy of blind needle placement and the value of a confirmatory epidurogram", Eur Spine J, 19, pp.1479~1483 (2010)
- el-Khoury GY, "Epidural steroid injection : a procedure ideally performed with fluoroscopic control", Radiology, 168, pp.554~557 (1988)
- Nikooseresht M, "Ultrasound as a screening tool for performing caudal epidural injections", Iran J Radiol, 11, pp.e13262~ (2014)
- Chen CP, "Ultrasound guidance in caudal epidural needle placement", Anesthesiology, 101, pp.181~184 (2004)
- Kim YH, "Assessment of factors affecting the difficulty of caudal epidural injections in adults using ultrasound", Pain Res Manag, 19, pp.275~279 (2014)
- Yoon JS, "The feasibility of color Doppler ultrasonography for caudal epidural steroid injection", Pain, 118, pp.210~214 (2005)
- Renfrew DL, "Correct placement of epidural steroid injections : fluoroscopic guidance and contrast administration", AJNR Am J Neuroradiol, 12, pp.1003~1007 (1991)
- Manchikanti L, "Evaluation of fluoroscopically guided caudal epidural injections", Pain Physician, 7, pp.81~92 (2004)
- Huang J, "Disadvantages of ultrasound guidance in caudal epidural needle placement", Anesthesiology, 102, pp.693~ (2005)
- Yoo Seokha, "Ultrasonography for lumbar neuraxial block", Anesthesia and Pain Medicine, 15(4), pp.397~408 (2020), 대한마취통증의학회[DOI]
- Chin KJ, "Ultrasonography of the adult thoracic and lumbar spine for central neuraxial blockade", Anesthesiology, 114, pp.1459~1485 (2011)
- Van Besien J, "Ultrasonography is not inferior to fluoroscopy to guide extracorporeal shock waves during treatment of renal and upper ureteric calculi : a randomized prospective study", Biomed Res Int, 2017, pp.7802672~ (2017)
- El-Yahchouchi C, "The noninferiority of the nonparticulate steroid dexamethasone vs the particulate steroids betamethasone and triamcinolone in lumbar transforaminal epidural steroid injections", Pain Med, 14, pp.1650~1657 (2013)
- Yokoyama M, "Correlation between the distribution of contrast medium and the extent of blockade during epidural anesthesia", Anesthesiology, 100, pp.1504~1510 (2004)
- Senkal S, Sir E, "Comparison of ultrasonography and conventional fluoroscopy guided caudal epidural injection in chronic low back pain", Turk Neurosurg, 31, pp.119~123 (2021)
- Dashe JS, "Effect of maternal obesity on the ultrasound detection of anomalous fetuses", Obstet Gynecol, 113, pp.1001~1007 (2009)
- Modica MJ, "The obese emergency patient : imaging challenges and solutions", Radiographics, 31, pp.811~823 (2011)
- Ji Seon Son, "A Comparison of Two Techniques for Ultrasound-guided Caudal Injection: The Influence of the Depth of the Inserted Needle on Caudal Block", The Korean Journal of Pain, 28(2), pp.122~128 (2015), 대한통증학회
- El-Boghdadly K, "Local anesthetic systemic toxicity : current perspectives", Local Reg Anesth, 11, pp.35~44 (2018)
- 두아람, "The prevalence and clinical significance of transitional vertebrae: a radiologic investigation using whole spine spiral three-dimensional computed tomographic images", Anesthesia and Pain Medicine, 15(1), pp.103~110 (2020), 대한마취통증의학회[DOI]