Inadvertent Intrafacet Injection during Lumbar Interlaminar Epidural Steroid Injection: A Comparison of CT...

Area of Science:

• Pain Management
• Radiology
• Interventional Procedures

Background:

• Inadvertent intrafacet injection is a risk during interlaminar epidural steroid injections.
• This can lead to inaccurate medication delivery and false loss of resistance.
• Comparing imaging guidance techniques is crucial for procedural safety.

Purpose of the Study:

• To compare the rates of inadvertent intrafacet injection during lumbar interlaminar epidural steroid injections.
• To evaluate the impact of conventional fluoroscopy versus CT fluoroscopic guidance on these rates.

Main Methods:

• Retrospective review of 349 lumbar interlaminar epidural steroid injections.
• Classification of intrafacet injections as recognized or unrecognized.
• Multivariate logistic regression analysis to assess imaging guidance, age, and sex effects.

Main Results:

• The rate of inadvertent intrafacet injection was 7.5% with CT fluoroscopy and 0.75% with conventional fluoroscopy.
• All CT-fluoroscopic cases were recognized; one conventional fluoroscopy case was not.
• Imaging guidance significantly impacted detection rates (OR=0.10, P=.03).

Conclusions:

• CT fluoroscopic guidance is associated with a 10-fold higher rate of inadvertent intrafacet injection.
• This suggests CT fluoroscopy may improve detection of this complication.
• Proceduralists should be aware of this increased rate with CT guidance.