title: A comparison of Quincke and Whitacre needles with respect to risk of intravascular uptake in S1 transforaminal epidural steroid injections: a randomized trial of 1376 cases.
abstract: BACKGROUND
  Transforaminal epidural steroid injection (TFESI) is a useful treatment modality for pain management. Most complications of TFESI are minor and transient. However, there is a risk of serious complications such as nerve injury, spinal cord infarct, or paraplegia. Some of the risks are related to direct injury to the vessel or intravascular injection of the particulate steroid. We prospectively tested the hypothesis that the intravascular injection rate of the Whitacre needle is lower than that of the Quincke needle during TFESI.
  
  
  METHODS
  This study was a randomized trial of 1376 TFESIs at the S1 level. We collected data of age, gender, height, weight, laterality (right/left), history of lumbosacral spine operation, history of appropriate interval discontinuation of anticoagulation medicines, and underlying disease. During the S1 TFESI, intrasacral bone contact, a blood aspiration test, and real-time fluoroscopy of the intravascular injection using contrast media were investigated.
  
  
  RESULTS
  There were no significant differences in the intravascular injection rate with respect to age, gender, height, weight, hypertension, diabetes mellitus, laterality, history of lumbosacral spine operation, or history of appropriate interval discontinuation of anticoagulation medicines. Intravascular injection was significantly associated with a blood aspiration test (P < 0.001), needle tip type (P = 0.002), intrasacral bone contact (P < 0.001), and physicians (some P < 0.05). The use of Quincke needles and intrasacral bone contact increased the rate of intravascular injection.
  
  
  CONCLUSIONS
  To reduce the risk of intravascular injection, the use of Whitacre needles without intrasacral bone contact may be a safer and more effective approach.
authors.affiliation: From the *Department of Anesthesiology and Pain Medicine, Seoul-Siwonhan Pain Clinic, Seongnam, Korea; †Department of Anesthesiology and Pain Medicine, Seoul National University Hospital; and ‡Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea.
authors.forename: Jaehyuck
authors.initials: J
authors.lastname: Shin
authors.forename: Yong Chul
authors.initials: YC
authors.lastname: Kim
authors.forename: Sang Chul
authors.initials: SC
authors.lastname: Lee
authors.forename: Jae Hun
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology; D001808:Blood Vessels / Q000187:drug effects; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000517:prevention & control; D005260:Female; D006801:Humans; D007268:Injections, Epidural / Q000295:instrumentation* / Q000379:methods; D017116:Low Back Pain / Q000188:drug therapy; D008161:Lumbosacral Region / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009339:Needles; D012306:Risk; D013256:Steroids / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D013256:Steroids