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Injectate Volumes Needed to Reach Specific Landmarks in S1 Transforaminal Epidural Injections.
MedLine Citation:
PMID:  22925558     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objectives.  We identify the contrast volumes needed to reach specific landmarks during S1 transforaminal epidural injections (S1-TFEIs). Design.  Prospective, nonrandomized, observational human study. Setting.  Academic/private pain management practice. Subjects.  Forty-two patients undergoing S1-TFEIs were investigated. Thirty-seven patients were included in this study. Interventions.  S1-TFEIs were performed using contrast-enhanced fluoroscopic visualization. Main Outcome Measurements.  After confirming appropriate spinal needle position, up to 5 mL of nonionic contrast was slowly injected. Under biplanar fluoroscopic guidance, contrast volumes were recorded as flow reached specific anatomic landmarks: the ipsilateral S1 pedicle, the superior aspect of the L5-S1 disc space, and across the midline of the spinous process. Results.  After injecting 2 mL of contrast, 100% of S1-TFEIs spread to the medial aspect of the ipsilateral superior pedicle of S1. After injecting 3.0 mL of contrast, 92% of S1-TFEIs spread to the superior aspect of the L5-S1 intervertebral disc. After injecting 4 mL of contrast, 27% of S1-TFEIs spread beyond the midline of the spinous process, but by only a few millimeters. Conclusions.  This study demonstrates injectate volumes needed to reach specific anatomic landmarks in S1-TFEIs. A volume of 3.0 mL of contrast reaches the superior aspect of the L5-S1 intervertebral disc 92% of the time.
Authors:
Michael B Furman; Sean P Butler; Ruby E Kim; Ariz R Mehta; Jeremy I Simon; Rikin Patel; Thomas S Lee; Ryan S Reeves
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-23
Journal Detail:
Title:  Pain medicine (Malden, Mass.)     Volume:  -     ISSN:  1526-4637     ISO Abbreviation:  Pain Med     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100894201     Medline TA:  Pain Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Wiley Periodicals, Inc.
Affiliation:
Pain Management, Orthopaedic and Spine Specialists, York, Pennsylvania Orthopaedic Surgery and Sports Medicine, Stamford, Connecticut Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School, New York, New York Rothman Institute, Philadelphia, Pennsylvania Mercerbucks Orthopedics, Hamilton, New Jersey Physical Medicine & Pain Management Associates, PC, Annapolis, Maryland Spine Team Texas, Southlake, Texas, USA.
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