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Analysis of Influencing Factors to Depth of Epidural Space for Lumbar Transforaminal Epidural Block in Korean

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Background:Transforaminal epidural steroid injection is one of the effective treatments in managing radicular pain. There have been some prospective studies on the depth to the epidural space with the transforaminal approach. However, there have been no studies about the depth in Asians, especially Koreans. This study was carried out in order to evaluate the depth to the epidural space and the oblique angle and factors that influence the depth to the epidural space during lumbar transforaminal epidural injection. Methods:A total of 248 patients undergoing fluoroscopically guided transforaminal epidural steroid injections were evaluated. At the L3−4, L4−5, L5−S1, and S1 levels, we measured the oblique angle and depth to the epidural space. Results:Needle depth was positively associated with body mass index (correlation coefficient 0.52, P = 0.004). The median depths (in centimeters) to the epidural space were 6.13 cm, 6.42 cm, and 7.13 cm for 50−60 kg, 60−70 kg, and 70−80 kg groups, respectively, at L5−S1. Age and height were not significantly associated with the needle depth. Conclusions:There is a positive association between the BMI (and weight) and transforaminal epidural depth but not with age, sex, and height. (Korean J Pain 2011; 24: 216-220)

Abstract

Background:Transforaminal epidural steroid injection is one of the effective treatments in managing radicular pain. There have been some prospective studies on the depth to the epidural space with the transforaminal approach. However, there have been no studies about the depth in Asians, especially Koreans. This study was carried out in order to evaluate the depth to the epidural space and the oblique angle and factors that influence the depth to the epidural space during lumbar transforaminal epidural injection. Methods:A total of 248 patients undergoing fluoroscopically guided transforaminal epidural steroid injections were evaluated. At the L3−4, L4−5, L5−S1, and S1 levels, we measured the oblique angle and depth to the epidural space. Results:Needle depth was positively associated with body mass index (correlation coefficient 0.52, P = 0.004). The median depths (in centimeters) to the epidural space were 6.13 cm, 6.42 cm, and 7.13 cm for 50−60 kg, 60−70 kg, and 70−80 kg groups, respectively, at L5−S1. Age and height were not significantly associated with the needle depth. Conclusions:There is a positive association between the BMI (and weight) and transforaminal epidural depth but not with age, sex, and height. (Korean J Pain 2011; 24: 216-220)

참고문헌 (6)

  1. 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
  2. Goodman BS, "Complications and pitfalls of lumbar interlaminar and transforaminal epidural injections", Curr Rev Musculoskelet Med, 1, pp.212~222 (2008)
  3. 김동원, "요추 경추간공 경막외강내 조영제 확산의 평가", The Korean Journal of Pain, 17(2), pp.10~10 (2004), 대한통증학회
  4. 최병인, "요하지통 환자에서 선택적 경추간공 경막외강 블록의 예후 인자", The Korean Journal of Pain, 20(1), pp.10~10 (2007), 대한통증학회
  5. 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)
  6. D'Alonzo RC, "Ethnicity and the distance to the epidural space in parturients", Reg Anesth Pain Med, 33, pp.24~29 (2008)

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