Image and Contrast Flow Pattern Interpretation for Attempted Epidural Steroid Injections.

Area of Science:

• Radiology
• Interventional Pain Management
• Spinal Anatomy

Background:

• Fluoroscopically guided, contrast-enhanced epidural steroid injections (ESIs) are common for radicular pain.
• Accurate injectate delivery relies on a deep understanding of spinal anatomy.

Purpose of the Study:

• To outline the characteristics distinguishing ideal epidural contrast flow from nonideal patterns.
• To enhance safety and efficacy of ESIs by recognizing suboptimal flow.

Main Methods:

• Review of fluoroscopic characteristics of contrast flow during ESIs.
• Identification of patterns indicative of epidural versus non-epidural spread.

Main Results:

• Key features differentiating ideal epidural flow from subarachnoid, intradural, and other non-target spread are detailed.
• Visual examples of optimal and suboptimal contrast distribution are presented.

Conclusions:

• Recognizing specific contrast flow patterns is essential for interventionalists performing ESIs.
• This knowledge is vital for successful procedures and avoiding complications.