TY - JOUR

T1 - Incidence of intravascular uptake in lumbar spinal injection procedures

AU - Sullivan, William J.

AU - Willick, Stuart E.

AU - Chira-Adisai, Waree

AU - Zuhosky, Joseph

AU - Tyburski, Mark

AU - Dreyfuss, Paul

AU - Prather, Heidi

AU - Press, Joel M.

PY - 2000/2/15

Y1 - 2000/2/15

N2 - Study Design. Multicenter, prospective, observational study. Objectives. To document the incidence of and factors associated with intravascular uptake during lumbar spinal injection procedures. Summary of Background Data. In prior reports, the incidence of inadvertent intravascular needle placement during contrast-enhanced, fluoroscopically guided lumbar spinal injection procedures has been incidentally noted to range from 6.4% to 9.2%. We present the first systematic prospective documentation of intravascular uptake of contrast dye during different types of lumbar injection procedures. Methods. Fifteen interventional spine physicians in seven centers recorded data regarding intravascular uptake during 1219 contrast-enhanced, fluoroscopically guided lumbar spinal injection procedures. Results. The overall incidence of intravascular uptake during lumbar spinal injection procedures as determined by contrast enhanced fluoroscopic observation is 8.5%. Caudal and transforaminal routes have the highest rates at 10.9% and 10.8%, respectively, followed by zygapophyseal joint (6.1%), sacroiliac joint (5.3%), and translaminar (1.9%) injections. Intravascular uptake is twice as likely to occur in those patients over rather than under 50 years of age. Preinjection aspiration failed to produce a flashback of blood in 74% of cases that proved to be intravascular upon injection of contrast dye. Conclusion. The incidence of intravascular uptake during lumbar spinal injection procedures is approximately 8.5%. The route of injection and the age of the patient greatly affect this rate. Absence of flashback of blood upon preinjection aspiration does not predict extravascular needle placement. Contrast-enhanced, fluoroscopic guidance is recommended when doing lumbar spinal injection procedures to prevent inadvertent intravascular uptake of injectate.

AB - Study Design. Multicenter, prospective, observational study. Objectives. To document the incidence of and factors associated with intravascular uptake during lumbar spinal injection procedures. Summary of Background Data. In prior reports, the incidence of inadvertent intravascular needle placement during contrast-enhanced, fluoroscopically guided lumbar spinal injection procedures has been incidentally noted to range from 6.4% to 9.2%. We present the first systematic prospective documentation of intravascular uptake of contrast dye during different types of lumbar injection procedures. Methods. Fifteen interventional spine physicians in seven centers recorded data regarding intravascular uptake during 1219 contrast-enhanced, fluoroscopically guided lumbar spinal injection procedures. Results. The overall incidence of intravascular uptake during lumbar spinal injection procedures as determined by contrast enhanced fluoroscopic observation is 8.5%. Caudal and transforaminal routes have the highest rates at 10.9% and 10.8%, respectively, followed by zygapophyseal joint (6.1%), sacroiliac joint (5.3%), and translaminar (1.9%) injections. Intravascular uptake is twice as likely to occur in those patients over rather than under 50 years of age. Preinjection aspiration failed to produce a flashback of blood in 74% of cases that proved to be intravascular upon injection of contrast dye. Conclusion. The incidence of intravascular uptake during lumbar spinal injection procedures is approximately 8.5%. The route of injection and the age of the patient greatly affect this rate. Absence of flashback of blood upon preinjection aspiration does not predict extravascular needle placement. Contrast-enhanced, fluoroscopic guidance is recommended when doing lumbar spinal injection procedures to prevent inadvertent intravascular uptake of injectate.

KW - Fluoroscopy

KW - Injections/radiography

KW - Intravascular

KW - Low back pain

UR - http://www.scopus.com/inward/record.url?scp=0033999576&partnerID=8YFLogxK

U2 - 10.1097/00007632-200002150-00015

DO - 10.1097/00007632-200002150-00015

M3 - Article

C2 - 10707395

AN - SCOPUS:0033999576

SN - 0362-2436

VL - 25

SP - 481

EP - 486

JO - Spine

JF - Spine

IS - 4

ER -