title: Differential Rates of Inadvertent Intravascular Injection during Lumbar Transforaminal Epidural Injections Using Blunt-Tip, Pencil-Point, and Catheter-Extension Needles.
abstract: OBJECTIVE
  To quantify the incidence of inadvertent vascular penetration during lumbosacral transforaminal epidural injections using blunt-tip, pencil-point, and catheter-extension needles.
  
  
  METHODS
  This is a prospective, observational, consecutive cohort study.
  
  
  METHODS
  Two hundred consecutive patients undergoing lumbosacral transforaminal epidural injections at an academic outpatient spine center.
  
  
  METHODS
  Four hundred seventy-five fluoroscopically guided lumbosacral transforaminal epidural injections were performed on consecutively consenting patients by one interventional spine physician, using three different needle types. The presence or absence of vascular uptake was determined during contrast injection under live fluoroscopy.
  
  
  RESULTS
  Vascular uptake of contrast was observed in 58 of the total 475 injections, for an overall incidence of 12.2%. By needle type, the incidence of inadvertent vascular uptake was 16.6% (26/157) in the pencil-point group, 15.6% (24/154) in the blunt-tip group, and 4.9% (8/164) in the catheter-extension group. The difference in rates is statistically significant between the catheter-extension needle group and both the pencil-point group (P = 0.0009) and blunt-tip group (P = 0.0024). A secondary analysis was performed to quantify the incidence of functional pitfalls between needle groups, with a significantly lower incidence in the pencil-point group compared to both the catheter-extension (P = 0.0148) and blunt-tip needle (P = 0.0288) groups.
  
  
  CONCLUSIONS
  Blunt-tip and pencil-point needles have comparable risk of inadvertent vascular injection during lumbosacral transforaminal injections. Catheter-extension needles demonstrated a reduce incidence of vascular uptake, but also result in a significantly higher rate of functional pitfalls that limits their usefulness in routine practice.
authors.affiliation: Department of Orthopaedic Surgery, Stanford University, Redwood City, California.
authors.forename: Matthew
authors.initials: M
authors.lastname: Smuck
authors.affiliation: Department of Orthopaedic Surgery, Stanford University, Redwood City, California.
authors.forename: Stephen
authors.initials: S
authors.lastname: Paulus
authors.affiliation: Department of Anesthesiology, University of Southern California, Los Angeles, California.
authors.forename: Ajay
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Orthopaedic Surgery, Confluence Health, Wenatchee, Washington, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Demirjian
authors.affiliation: Department of Orthopaedic Surgery, Stanford University, Redwood City, California.
authors.forename: Ma Agnes
authors.initials: MA
authors.lastname: Ith
authors.affiliation: Department of Orthopaedic Surgery, Stanford University, Redwood City, California.
authors.forename: David J
authors.initials: DJ
authors.lastname: Kennedy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007268:Injections, Epidural / Q000295:instrumentation*; D007275:Injections, Intravenous / Q000295:instrumentation* / Q000379:methods; D008161:Lumbosacral Region / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009339:Needles; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: Epidural; Fluoroscopy; Lumbar; Transforaminal