title: Incorrect needle position during lumbar epidural steroid administration: inaccuracy of loss of air pressure resistance and requirement of fluoroscopy and epidurography during needle insertion.
abstract: Loss of air pressure resistance leads to a high rate (25.7%) of inaccurate needle-tip placement in the posterior soft tissues of the back during lumbar epidural steroid administration employing a 20-gauge Tuohy needle. Imaging and epidurogram are essential for confident identification of the lumbar epidural space to enable accurate location of steroid administration. Studies assessing efficacy of lumbar epidural steroid injection and individual patient treatments should ensure location of administration with epidurogram to enhance the validity of results.
authors.affiliation: Department of Radiology, Division of Neuroradiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. bartynskiws@upmc.edu
authors.forename: Walter S
authors.initials: WS
authors.lastname: Bartynski
authors.forename: Stephen Z
authors.initials: SZ
authors.lastname: Grahovac
authors.forename: William E
authors.initials: WE
authors.lastname: Rothfus
mesh_terms: D000328:Adult; D000399:Air Pressure; D004824:Epidural Space / Q000000981:diagnostic imaging*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects*; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000188:drug therapy; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000188:drug therapy; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D013256:Steroids