The Role of Spectral Tissue Sensing During Lumbar Transforaminal Epidural Injection.
Spectral tissue sensing (STS) exploits the scattering and absorption of light by tissue. The main objective of the present study was to determine whether STS can discriminate between correct and incorrect placement of the needle tip during lumbar transforaminal epidural injection. This was a single-blind prospective observational study in 30 patients with lumbar radicular pain scheduled for lumbar transforaminal epidural injection. Spectral tissue sensing data from the needle tip were acquired along the needle trajectory at 4 predefined measurement points and compared with ultrasound, fluoroscopy, and digital subtraction angiography images. Spectral tissue sensing data contained the full spectra. The lipid and hemoglobin content at the different measurement points was also calculated, and partial least-squares discriminant analysis was used to estimate the sensitivity and specificity of STS. Spectral tissue sensing identified correct needle placement with a sensitivity of 57% and a specificity of 82%, and intraforaminal versus extraforaminal locations were identified with a sensitivity of 80% and a specificity of 71%.
From the *Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht; †Philips Healthcare, Best; Departments of ‡Radiology and §Clinical Epidemiology & Medical Technology Assessment, Maastricht University Medical Center; and ‖Department of Anatomy and Embryology, Maastricht University, Maastricht; and ¶Department of Anesthesiology, VU University Medical Center Amsterdam, Amsterdam, the Netherlands.
Andrea J R
AJ
Balthasar
Gerald W
GW
Lucassen
Micha
M
Sommer
Marjolein
M
van der Voort
Geert
G
Gijsbers
Carsten W K P
CW
Arnoldussen
Alfons
A
Kessel
Stefan
S
Roggeveen
Arno
A
Lataster
Maarten
M
van Kleef
D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D015901:Angiography, Digital Subtraction; D001416:Back Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D016002:Discriminant Analysis; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007268:Injections, Epidural; D016018:Least-Squares Analysis; D008027:Light; D008159:Lumbar Vertebrae / Q000187:drug effects* / Q000294:innervation; D008297:Male; D008875:Middle Aged; D009339:Needles; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000379:methods; D012542:Scattering, Radiation; D016037:Single-Blind Method; D013057:Spectrum Analysis; D018084:Ultrasonography, Interventional