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CT Fluoroscopy-Guided Interlaminar Epidural Steroid Injections in the Cervical Spine: Rate of Nontarget Injection Into the Retrodural Space of Okada.

Publication ,  Journal Article
Parivash, SN; Kranz, PG; Gray, L; Amrhein, TJ
Published in: AJR Am J Roentgenol
August 2018

OBJECTIVE: The purpose of this study was to assess the rate of inadvertent injection into the retrodural space of Okada during CT fluoroscopy-guided interlaminar epidural steroid injection in the cervical spine. MATERIALS AND METHODS: Images from cases of cervical interlaminar epidural steroid injection under CT fluoroscopic guidance performed at a single institution between November 2009 and November 2015 were obtained and reviewed. For all cases, the following information was recorded: presence or absence of contrast material within the Okada space, cervical anatomic level at which the procedure was performed, laterality of approach, trainee presence, and years of proceduralist experience. Two-tailed chi-square tests were used to assess categoric variables, and t tests were performed to assess for continuous variables predictive of nontarget injection. RESULTS: A total of 974 CT fluoroscopy-guided cervical interlaminar epidural steroid injections were identified in 728 patients. The presence of contrast material in the retrodural space of Okada was identified in 2.9% of cases (28/974). All cases of inadvertent injection were identified and corrected intraprocedurally. The greatest rate of inadvertent injection (4.6% [18/389]) occurred at C5-6. No variables predictive of inadvertent injection into the Okada space were identified. There was a 0.4% (4/974) complication rate, and all complications were minor. CONCLUSION: We identified a 2.9% rate of unintended injection into the retrodural space of Okada during cervical interlaminar epidural steroid injection. If unrecognized, these nontarget injections can result in treatment failure in a subset of patients who undergo cervical interlaminar epidural steroid injection. Future study is warranted to assess the rate of inadvertent Okada injection under conventional fluoroscopy and to compare the rates of detection between the two imaging-guided modalities.

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Published In

AJR Am J Roentgenol

DOI

EISSN

1546-3141

Publication Date

August 2018

Volume

211

Issue

2

Start / End Page

426 / 431

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Steroids
  • Retrospective Studies
  • Radiography, Interventional
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Iopamidol
  • Injections, Epidural
  • Humans
 

Citation

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ICMJE
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Parivash, S. N., Kranz, P. G., Gray, L., & Amrhein, T. J. (2018). CT Fluoroscopy-Guided Interlaminar Epidural Steroid Injections in the Cervical Spine: Rate of Nontarget Injection Into the Retrodural Space of Okada. AJR Am J Roentgenol, 211(2), 426–431. https://doi.org/10.2214/AJR.18.19606
Parivash, Sherveen N., Peter G. Kranz, Linda Gray, and Timothy J. Amrhein. “CT Fluoroscopy-Guided Interlaminar Epidural Steroid Injections in the Cervical Spine: Rate of Nontarget Injection Into the Retrodural Space of Okada.AJR Am J Roentgenol 211, no. 2 (August 2018): 426–31. https://doi.org/10.2214/AJR.18.19606.
Parivash, Sherveen N., et al. “CT Fluoroscopy-Guided Interlaminar Epidural Steroid Injections in the Cervical Spine: Rate of Nontarget Injection Into the Retrodural Space of Okada.AJR Am J Roentgenol, vol. 211, no. 2, Aug. 2018, pp. 426–31. Pubmed, doi:10.2214/AJR.18.19606.

Published In

AJR Am J Roentgenol

DOI

EISSN

1546-3141

Publication Date

August 2018

Volume

211

Issue

2

Start / End Page

426 / 431

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Steroids
  • Retrospective Studies
  • Radiography, Interventional
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Iopamidol
  • Injections, Epidural
  • Humans