Image and Contrast Flow Pattern Interpretation for Attempted Epidural Steroid Injections - 23/11/17

Doi : 10.1016/j.pmr.2017.08.003

Michael B. Furman, MD, MS ^a,^b,^c,^⁎ , Anthony A. Cuneo, MD, PhD ^d
^a Interventional Spine and Sports, OSS Health, York, PA, USA
^b Rehabilitation Medicine, Sinai Hospital, Baltimore, MD, USA
^c Physical Medicine and Rehabilitation, Temple University School of Medicine, Philadelphia, PA, USA
^d Interventional Pain Management Physician, The Orthopedic Group, 1145 Bower Hill Road #301, Pittsburgh, PA 15243, USA

^∗Physical Medicine and Rehabilitation, Temple University School of Medicine, 3500 N Broad Street, Philadelphia, PA 19140.Physical Medicine and RehabilitationTemple University School of Medicine3500 N Broad StreetPhiladelphiaPA19140

Résumé

Fluoroscopically guided, contrast-enhanced epidural steroid injections (ESIs) are frequently performed for radicular symptoms. Interventionalists performing these procedures should have a thorough and detailed understanding of spinal anatomy to safely and effectively deliver the desired injectate to the targeted site. Being able to differentiate epidural from nonepidural contrast flow is vital as is recognizing flow to undesired locations. This article summarizes the characteristics that distinguish between ideal epidural flow patterns and nonideal subarachnoid, intradural, and other suboptimal contrast flow patterns. Recognizing these patterns is essential for safe and successful ESIs and to prevent avoidable complications.

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Keywords : Contrast flow patterns, Interventional spine procedures, Epidural steroid injections, Epidural contrast flow, Subarachnoid contrast flow