Influence of needle type on the incidence of intravascular injection during transforaminal epidural injections: a comparison of short-bevel and long-bevel needles.
BACKGROUND
Vascular penetration and injection of corticosteroids into a vessel during lumbosacral transforaminal epidural injection is a suspected cause of myelopathy. Blunt needles have been suggested to avoid vascular penetration, but they are difficult to navigate. Another alternative to the standard long-bevel sharp needles is the short-bevel needles. Some have postulated that short-bevel needles are the best option for high-risk spine injections because they maintain navigation characteristics while potentially reducing the risk of complications. To date, no studies have been performed to either confirm or refute this.


OBJECTIVE
The purpose of this study was to determine if there is a difference in the incidence of vascular penetration during lumbosacral transforaminal epidural injections between short-bevel and long-bevel needles.


METHODS
This is a prospective, observational, in vivo study.


METHODS
The sample comprises patients receiving lumbosacral transforaminal epidural injections at a university-based outpatient spine center.


METHODS
The outcome measure was the incidence of vascular contrast patterns observed under live fluoroscopy.


METHODS
One interventional spine physician recorded contrast patterns observed during 158 fluoroscopically guided lumbosacral transforaminal epidural injections under live fluoroscopy using two different types of needle tips.


RESULTS
Vascular injections were observed in 22 of the 158 injections, for an overall incidence of 13.9%. The incidence of vascular injections in the short-bevel group was 15.6% (10/64) and in the long-bevel group was 12.8% (12/94). This difference was not statistically significant (p=.6447). A secondary analysis was performed to determine if the needle gauge influenced the incidence of vascular injections, and again, there were no statistical differences in the overall rates of vascular injection.


CONCLUSIONS
In comparison with long-bevel needles, short-bevel needles do not reduce the risk of inadvertent vascular injection in lumbosacral transforaminal epidural injections.
Smuck
Matthew
M
Department of Orthopaedic Surgery, Stanford University Spine Center, Redwood City, CA 94063, USA. msmuck@stanford.edu
Yu
Andrew J
AJ
Tang
Chi-Tsai
CT
Zemper
Eric
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001808:Blood Vessels / Q000293:injuries*; D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D008161:Lumbosacral Region / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009339:Needles; D015641:Radiography, Interventional; D055815:Young Adult
D003287:Contrast Media; D005938:Glucocorticoids