The rate of detection of intravascular injection in cervical transforaminal epidural steroid injections with and without digital subtraction angiography.
OBJECTIVE
To determine whether digital subtraction angiography (DSA) combined with real-time fluoroscopic imaging improves the detection rate of intravascular injection during cervical transforaminal epidural steroid injections (CTFESIs).


METHODS
Retrospective analysis.


METHODS
Outpatient surgery center.


METHODS
A total of 134 subjects with cervical radicular pain who had CTFESIs performed by a single physician between June 9, 2004, and April 23, 2007.


METHODS
One hundred seventy-seven CTFESIs performed at one or more cervical spinal levels either unilaterally or bilaterally. Procedures performed before September 12, 2005, used fluoroscopic guidance with contrast injection and live imaging to identify intravascular injection. All procedures performed after September 12, 2005, also included DSA.


METHODS
Intravascular injection detected during CTFESIs with and without DSA.


RESULTS
Intravascular injection was detected in 17.9% of CTFESIs performed without DSA. By adding DSA technology to the real-time fluoroscopic imaging procedure, the detection of vascular injection nearly doubled to 32.8%, which was statistically significant (P = .0471).


CONCLUSIONS
The use of DSA improves the detection rate of intravascular injection during CTFESIs.
McLean
James P
JP
Spine Center, Kansas University Medical Center; Kansas City, KS, USA.
Sigler
James D
JD
Plastaras
Christopher T
CT
Garvan
Cynthia Wilson
CW
Rittenberg
Joshua D
JD
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D001808:Blood Vessels; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D016009:Chi-Square Distribution; D003287:Contrast Media; D003907:Dexamethasone / Q000008:administration & dosage*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010147:Pain Measurement; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
D003287:Contrast Media; D005938:Glucocorticoids; D003907:Dexamethasone