title: Gadolinium use in spine pain management procedures for patients with contrast allergies: results in 527 procedures.
abstract: BACKGROUND
  To review the safety and efficacy of gadolinium in spine pain management procedures in patients at high risk for a contrast reaction and who are not suitable candidates for the use of standard non-ionic contrast.
  
  
  METHODS
  We reviewed records over a 61-month period of all image-guided spinal pain management procedures where patients had allergies making them unsuitable candidates for standard non-ionic contrast and where gadolinium was used to confirm needle tip placement prior to injection of medication.
  
  
  RESULTS
  Three hundred and four outpatients underwent 527 procedures. A spinal needle was used in all but 41 procedures. Gadolinium was visualized using portable C-arm fluoroscopy in vivo allowing for confirmation of needle tip location. The gadolinium dose ranged from 0.2 to 10 ml per level. The highest dose received by one patient was 15.83 ml intradiscally during a three-level discogram. Three hundred and one patients were discharged without complication or known delayed complications. One patient had documented intrathecal injection but without sequelae and 2 patients who underwent cervical procedures experienced seizures requiring admission to the intensive care unit. Both the latter patients were discharged without any further complications.
  
  
  CONCLUSIONS
  Based on our experience we recommend using gadolinium judiciously for needle tip confirmation. We feel more confident using gadolinium in the lumbar spine and in cervical nerve blocks. Gadolinium should probably not be used as an injectate volume expander. The indications for gadolinium use in cervical needle-guided spine procedures are less clear and use of a blunt-tipped needle should be considered.
authors.affiliation: Neuroradiology Section, Department of Radiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA. safriel@yale.edu
authors.forename: Yair
authors.initials: Y
authors.lastname: Safriel
authors.forename: Roberto
authors.initials: R
authors.lastname: Ang
authors.forename: Muhammed
authors.initials: M
authors.lastname: Ali
mesh_terms: D001416:Back Pain / Q000188:drug therapy*; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000209:etiology*; D005471:Fluoroscopy; D019786:Gadolinium DTPA / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007268:Injections, Epidural; D007472:Iohexol / Q000008:administration & dosage / Q000009:adverse effects*; D015641:Radiography, Interventional; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D007472:Iohexol; D019786:Gadolinium DTPA