Gadolinium use in spine procedures for patients with allergy to iodinated contrast--experience of 127 procedures

To review the safety and efficacy of gadolinium as a contrast agent in spine pain management procedures in patients who are at high risk for a contrast reaction and are therefore unacceptable candidates for the use of standard nonionic contrast.

We reviewed our records over a 4-year period of interlaminar and foraminal epidural steroid injections, nerve blocks, facet injections, intercostal blocks, and diskograms in the lumbar, thoracic, and cervical spine for cases in which patients had allergies that made them unsuitable candidates for standard nonionic contrast and where gadolinium was used to confirm needle tip placement before injection of medication.

Ninety-two patients underwent 127 procedures. A spinal needle was used in all but 7 procedures. All patients were outpatients and all were discharged without complication after 20 to 45 minutes with follow-up instructions. No delayed complications were reported. Gadolinium was visualized by using portable C-arm fluoroscopy in vivo allowing for confirmation of needle tip location. For epidural steroid injection, the gadolinium dose ranged from 1 to 5 mL, nerve blocks from 0.2 to 1 mL per level, facet injections from 0.2 to 0.5 mL per level, intercostal blocks used 0.5 mL, and diskograms from 1.5 to 7.5 mL per level. The highest dose received by 1 patient was an intradiskal 15.83 mL during a 3-level diskogram.

Gadolinium seems to be a safe alternative to standard nonionic contrast in spine pain management procedures in those patients considered to be at high risk for a contrast reaction.