Abstract:
:STUDY DESIGN A prospective, observational, human, study was conducted. OBJECTIVES To evaluate the incidence of vascular penetration during fluoroscopically guided, contrast-enhanced transforaminal cervical epidural steroid injections, and to determine whether the observation of blood in the needle hub can be used to predict a vascular injection. SUMMARY OF BACKGROUND DATA Incorrectly placed intravascular cervical spinal injections result in medication flow systemically and not to the desired target. A recently published study demonstrates a high incidence of intravascular injections in transforaminal lumbosacral epidural injections. No studies so far have evaluated the incidence of vascular injections in transforaminal cervical epidural steroid injections, nor have they calculated the ability of observed blood in the needle hub to predict a vascular injection in the cervical spine.METHODS The incidence of fluoroscopically confirmed intravascular uptake of contrast was prospectively observed in 337 patients treated with cervical transforaminal epidural steroid injections. The ability of observed blood in the needle hub to predict intravascular injection was also investigated. For each subject, the injection level was chosen on the basis of the clinical scenario including history, physical examination, and review of imaging studies. Some patients had multilevel injections. Using fluoroscopic guidance, the authors placed a 25-gauge needle into the epidural space using a transforaminal approach according to accepted standard technique. Needle tip location was confirmed with biplanar imaging. The presence or absence of blood in the needle hub spontaneously ("flash") and after attempted aspiration by pulling back on the syringe's plunger was documented. Contrast then was injected under real-time fluoroscopy to determine whether the location of the needle tip was intravascular. The results were recorded in a prospective manner indicating the presence or absence of blood in the needle hub and whether a vascular pattern was noted with contrast injection, and these were correlated. Relevant epidemiologic data also were recorded. RESULTS The study included 504 transforaminal epidural steroid injections. The overall rate of fluoroscopically confirmed intravascular contrast injections was 19.4%. Use of observed blood in the needle hub to predict intravascular injections was 97% specific, but only 45.9% sensitive. There was no significant difference in intravascular rates related to age or gender. CONCLUSIONS As compared with a previous study of lumbosacral epidural steroid injections, there is an overall higher incidence of intravascular injections with cervical transforaminal epidural steroid injections. Use of observed blood in the needle hub to predict an intravascular injection is not sensitive, and therefore the absence of blood in the needle hub despite aspiration is not reliable. The reported sensitivity and specificity rates are similar to lumbar data. Fluoroscopically guided procedures without contrast confirmation instill medications intravascularly, and therefore not in the desired epidural location. This study confirms that there is a need not only for fluoroscopic guidance, but also for contrast instillation in cervical transforaminal epidural steroid injections.
journal_name
Spine (Phila Pa 1976)journal_title
Spineauthors
Furman MB,Giovanniello MT,O'Brien EMdoi
10.1097/00007632-200301010-00007keywords:
subject
Has Abstractpub_date
2003-01-01 00:00:00pages
21-5issue
1eissn
0362-2436issn
1528-1159journal_volume
28pub_type
杂志文章相关文献
SPINE文献大全abstract:STUDY DESIGN:: A formal systematic review of the literature for conservative treatment of adult deformity was performed. OBJECTIVE:: To evaluate evidence for the efficacy and effectiveness of proposed conservative treatment options in adult deformity. SUMMARY OF BACKGROUND DATA:: Adult deformity is a major demographi...
journal_title:Spine
pub_type: 杂志文章,评审
doi:10.1097/BRS.0b013e318134ea88
更新日期:2007-09-01 00:00:00
abstract:STUDY DESIGN:The accuracy and interobserver agreement of fine detail radiography and computed tomography (CT) determination of spinal fusion were evaluated in an established animal spine fusion model. OBJECTIVE:To determine the accuracy and interobserver agreement of radiographic determinations of spinal fusion in rab...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/01.brs.0000127184.43765.61
更新日期:2004-06-15 00:00:00
abstract:STUDY DESIGN:Retrospective, case-control, matched cohort. OBJECTIVE:Compare the radiographic and clinical outcomes of adult spinal deformity patients treated with thoracic pedicle screw (TPS) or thoracic hook constructs. SUMMARY OF BACKGROUND DATA:The efficacy of TPS instrumentation for pediatric spinal deformity cor...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/01.brs.0000256445.31653.0e
更新日期:2007-03-01 00:00:00
abstract::Electromyographic studies have determined that muscle imbalance and asymmetry of stretch receptors in the paraspinal muscle of patients with idiopathic scoliosis may have a large role to play in the development and production of the deformity. This project consisted of a detailed histologic and histochemical analysis ...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/00007632-198805000-00004
更新日期:1988-05-01 00:00:00
abstract:STUDY DESIGN:An in vitro immature bovine study of thoracic spine fixation using shape memory alloy for minimally invasive adolescent scoliosis treatment. OBJECTIVE:The purpose of this study was to detect differences in thoracic spine range of motion due to the placement of spinal staples manufactured from a common sha...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/01.brs.0000259073.16006.ed
更新日期:2007-04-01 00:00:00
abstract::Seventeen patients were identified with concomitant thoracolumbar and sacral fractures representing 26% of sacral fractures and 7.7% of pelvic fractures. The thirteen men and four women exhibited a bimodal age distribution. There were thirteen vertical compression thoracolumbar fractures, three transverse process frac...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/00007632-199308000-00007
更新日期:1993-08-01 00:00:00
abstract:STUDY DESIGN:Case-control study. OBJECTIVE:To identify laboratory markers for surgical site infection (SSI) in posterior lumbar decompression surgery, which are not affected by operative factors, and to determine the diagnostic cutoffs of these markers. SUMMARY OF BACKGROUND DATA:Numerous laboratory markers are used ...
journal_title:Spine
pub_type: 杂志文章,多中心研究
doi:10.1097/BRS.0000000000002617
更新日期:2018-09-15 00:00:00
abstract:STUDY DESIGN:Systematic review. OBJECTIVE:To review the evidence regarding the mechanism of action of mobilizations. SUMMARY OF BACKGROUND DATA:Spinal mobilizations-low velocity passive oscillatory movements-reduce spinal pain in some patient subgroups. Identifying patients likely to respond remains a challenge since...
journal_title:Spine
pub_type: 杂志文章,评审
doi:10.1097/BRS.0000000000001151
更新日期:2016-01-01 00:00:00
abstract:STUDY DESIGN:A 12-week bovine survival study of tethering anterior spine growth that included untethered control subjects. OBJECTIVE:To determine the effects that a flexible cable attached to the anterolateral aspect of the thoracic spine has on spine growth in rapidly growing calves. SUMMARY OF BACKGROUND DATA:The s...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/00007632-200204010-00004
更新日期:2002-04-01 00:00:00
abstract:STUDY DESIGN:A retrospective case series. OBJECTIVE:The aim of this study was to evaluate patients with cervical spine osteomyelitis who underwent multilevel (≥2) subaxial corpectomies and anterior column reconstruction and plating. SUMMARY OF BACKGROUND DATA:Neglected multilevel subaxial cervical osteomyelitis is a ...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0000000000001557
更新日期:2016-09-15 00:00:00
abstract:STUDY DESIGN:Cross-sectional study. OBJECTIVE:The present study compared activity of deep and superficial cervical flexor muscles and craniocervical flexion range of motion during a test of craniocervical flexion between 10 patients with chronic neck pain and 10 controls. SUMMARY OF BACKGROUND DATA:Individuals with c...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/01.brs.0000141170.89317.0e
更新日期:2004-10-01 00:00:00
abstract:STUDY DESIGN:Retrospective study. OBJECTIVE:To report results at a minimum 5 years after pedicle subtraction osteotomy for fixed sagittal imbalance. SUMMARY OF BACKGROUND DATA:No one has reported results of pedicle subtraction osteotomies with a 5- to 8-year follow-up. METHOD:Thirty-five consecutive patients with sa...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0b013e31814b8371
更新日期:2007-09-15 00:00:00
abstract:METHODS:Eleven patients with paralysis, secondary to rheumatoid arthritis of the cervical spine were analyzed postmortem. Neurologic classification (Ranawat) included one Class 2, four Class IIIA, and six Class IIIB. Rheumatologic changes included atlantoaxial subluxation, basilar invagination, and subaxial subluxation...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/00007632-199410150-00004
更新日期:1994-10-15 00:00:00
abstract:STUDY DESIGN:A biomechanical cadaveric study of thoracic and lumbar vertebrae with simulated metastases quantifying intravertebral pressures during transpedicular vertebroplasty. OBJECTIVE:To compare intravertebral pressures during percutaneous vertebroplasty in vertebrae with and without simulated lytic metastases. ...
journal_title:Spine
pub_type: 杂志文章
doi:
更新日期:2003-07-15 00:00:00
abstract:STUDY DESIGN:Retrospective 2:1 propensity score-matched analysis on a national longitudinal database between 2006 and 2010. OBJECTIVE:To compare rates of adverse events, revisions procedure rates, and payment differences in anterior cervical fusion procedures compared with posterior laminectomy and fusion procedures w...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0000000000000872
更新日期:2015-07-01 00:00:00
abstract:STUDY DESIGN:A prospective study was done to assess the diagnostic value of radionuclide imaging (bone scan) in the evaluation of sacroiliac joint syndrome OBJECTIVES:To determine the sensitivity and specificity of radionuclide imaging in establishing a diagnosis of sacroiliac joint syndrome in patients with low back ...
journal_title:Spine
pub_type: 临床试验,杂志文章
doi:10.1097/00007632-199610010-00013
更新日期:1996-10-01 00:00:00
abstract::An anatomic study of lumbar nerve root lesions in the foraminal zone was performed on 35 cadavers. Two morphologic abnormalities of the nerve roots in the intervertebral foramen were found. The first was an abnormal transverse course of the nerve roots. The second was an indentation on the dorsal root ganglia caused b...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/00007632-199311000-00017
更新日期:1993-11-01 00:00:00
abstract:STUDY DESIGN:A biomechanical study was performed using cadaveric cervical spine specimens. OBJECTIVE:To determine the effect of cervical spine fusion on adjacent-level intradiscal pressure. SUMMARY OF BACKGROUND DATA:Clinical studies have reported that patients with spinal fusion are at greater risk of pathology and ...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/00007632-200211150-00003
更新日期:2002-11-15 00:00:00
abstract:STUDY DESIGN:Retrospective analysis. OBJECTIVE:The objective of this study was to describe the microbiology of surgical site infection (SSI) in spine surgery and relationship with surgical management characteristics. SUMMARY OF BACKGROUND DATA:SSI is an important complication of spine surgery that results in signific...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0b013e3182a42a68
更新日期:2013-10-15 00:00:00
abstract:STUDY DESIGN:Prospective, multicenter cohort analysis. OBJECTIVE:Assess children and guardian's comprehension of surgical consent for adolescent idiopathic scoliosis (AIS) surgery and factors associated with their comprehension. SUMMARY OF BACKGROUND DATA:Informed consent is essential to the ethical practice of surge...
journal_title:Spine
pub_type: 杂志文章,多中心研究
doi:10.1097/BRS.0000000000001162
更新日期:2016-01-01 00:00:00
abstract:STUDY DESIGN:A report of a case of lumbar spine duplication with the clinical appearance of adolescent scoliosis. OBJECTIVE:To increase knowledge about the pathogenesis and treatment of lumbar spinal duplication. SUMMARY OF BACKGROUND DATA:Although there have been other reports of lumbar spine duplication of this mag...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/00007632-199802150-00021
更新日期:1998-02-15 00:00:00
abstract:STUDY DESIGN:Biomechanical spine model. Comparison of stress in the implant and the adjacent cranial segment was done with conventional rigid versus dynamic stabilization system (DS) fixation. OBJECTIVE:The aim of this study was to study stress at the proximal end of spinal fixation with a novel DS. SUMMARY OF BACKGR...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0000000000003862
更新日期:2020-12-08 00:00:00
abstract::An electronic bone growth stimulator (EBGS) had been devised to facilitate lumbosacral fusion in the early 1970s, using a totally implanted device which delivers a steady 5 microA at each of four cathodes. The use of the device is reserved for patients in whom painful and abnormal motion is demonstrated to be the majo...
journal_title:Spine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00007632-198803000-00026
更新日期:1988-03-01 00:00:00
abstract:STUDY DESIGN:Retrospective radiographical study. OBJECTIVE:To compare the sex differences in curve patterns and radiographical characteristics in patients who have adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA:Sex differences in AIS have been documented in the incidence of curve progression, respo...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0b013e3182511d0c
更新日期:2012-08-15 00:00:00
abstract:STUDY DESIGN:A prospective clinical research article. OBJECTIVE:The primary goals were to determine (1) radiation exposure to the spine surgeon with the use of an intraoperative 3-dimensional imaging system and (2) to define the safe distance from the computed tomographic scanner. SUMMARY OF BACKGROUND:Intraoperative...
journal_title:Spine
pub_type: 临床试验,杂志文章
doi:10.1097/BRS.0b013e31825786d8
更新日期:2012-08-01 00:00:00
abstract:STUDY DESIGN:Prospective study on intraoperative blood loss during lumbar spine surgery. OBJECTIVE:To evaluate the relationship between airway pressure change due to the patient's prone position and intraoperative blood loss during lumbar spine surgery. SUMMARY OF BACKGROUND DATA:A prone position may increase abdomin...
journal_title:Spine
pub_type: 临床试验,杂志文章
doi:10.1097/BRS.0b013e31828cb3e5
更新日期:2013-05-15 00:00:00
abstract:STUDY DESIGN:A study of the histologic changes of the intervertebral discs (IVDs) in biglycan (Bgn)-deficient mice. OBJECTIVE:In this study, we investigate whether the absence of Bgn accelerates the degenerative process in mouse intervertebral disc (IVD). SUMMARY OF BACKGROUND DATA:Proteoglycans and collagen fibrils ...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0b013e3181b7c7ec
更新日期:2009-12-01 00:00:00
abstract:STUDY DESIGN:Cerebrospinal fluid (CSF) from dogs with intervertebral disc herniation (IVDH) were analyzed using a specific antibody against cartilage oligomeric matrix protein (COMP). Immunolocalization and genetic expression of COMP were also examined in the spinal cords of mouse, rat, and dog. OBJECTIVE:To investiga...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0b013e3181b61f14
更新日期:2010-01-01 00:00:00
abstract:STUDY DESIGN:To analyze the effects of tumor necrosis factor-alpha, interleukin-1beta, and interferon-gamma on cauda equina function and to define if any of these cytokines could induce nerve root dysfunction comparable with the situation with application of nucleus pulposus. SUMMARY OF BACKGROUND DATA:Proinflammatory...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/00007632-200208010-00004
更新日期:2002-08-01 00:00:00
abstract:STUDY DESIGN:The histologic and biomechanic characteristics of posterior lumbar fusion with varying rigidity of a novel internal fixation construct in the rabbit were analyzed. OBJECTIVES:To evaluate this rabbit model for future studies of fusion augmentation. SUMMARY OF BACKGROUND DATA:Previous studies in goats and ...
journal_title:Spine
pub_type: 杂志文章
doi:
更新日期:1995-07-15 00:00:00