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Radicular pain avoidance during needle placement in lumbar diskography.
Vibhu Kapoor1, William E Rothfus, Stephen Z Grahovac
1Department of Radiology, Division of Neuroradiology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213, USA.
AJR. American Journal of Roentgenology
|September 23, 2003
Summary
A new "safe window" technique significantly reduces iatrogenic radicular pain during lumbar diskography needle placement. This method improves patient comfort and the reliability of diagnostic imaging for spinal conditions.
Area of Science:
- Radiology
- Neurosurgery
- Pain Management
Background:
- Lumbar diskography is a diagnostic procedure for evaluating low back pain.
- Iatrogenic radicular pain is a common complication during needle placement in lumbar diskography.
- Current needle placement techniques lack predictability in averting pain.
Purpose of the Study:
- To determine a method for reducing iatrogenic radicular pain during lumbar diskography needle placement.
- To identify a safe anatomical target for needle insertion to minimize pain.
Main Methods:
- Retrospective analysis of 71 lumbar diskographies with random needle placement (superior vs. inferior).
- Identification of a "safe window" on MRI and fluoroscopy, defined by anatomical landmarks.
- Prospective application of the "safe window" technique in 73 lumbar diskographies.
Main Results:
- Random needle placement resulted in radicular pain in 50.7% of cases (18.3% superior, 32.4% inferior).
- The "safe window" technique significantly reduced radicular pain to 6.8% (p < 0.001).
- Anatomical measurements confirmed proximity of neural structures to randomly placed needles.
Conclusions:
- Iatrogenic radicular pain is frequent with random needle placement in lumbar diskography.
- The identified "safe window" provides a reliable method to minimize iatrogenic radicular pain.
- This technique enhances the safety and diagnostic accuracy of lumbar diskography.