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Contrast flow patterns based on needle tip position during cervical transforaminal epidural injections.

Josh Levin^1,2, David Levi³, Nolan Gall¹

¹Department of Orthopaedic Surgery, Stanford University, Virginia Beach, Virginia, USA.

PM & R : the Journal of Injury, Function, and Rehabilitation

|March 27, 2021

Summary

Needle tip position significantly impacts contrast flow during cervical transforaminal epidural steroid injections (TFESIs). Medial needle placement is associated with more optimal epidural and intraforaminal contrast spread in TFESI procedures.

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Area of Science:

Pain Management
Interventional Radiology
Neurosurgery

Background:

Limited research exists on how final needle placement affects contrast flow in cervical transforaminal epidural steroid injections (TFESIs).
Understanding these patterns is crucial for optimizing injection techniques.

Purpose of the Study:

To analyze contrast flow patterns during fluoroscopically guided cervical TFESIs.
To correlate these patterns with the final needle tip position.

Main Methods:

A retrospective observational study of 100 consecutive patients undergoing cervical TFESIs.
Two independent observers reviewed and classified contrast flow patterns based on needle tip location.
Interrater reliability was assessed using kappa values.

Main Results:

Medially placed needles (middle and lateral thirds of articular pillars) showed higher rates of epidural contrast flow (75% and 60%) compared to laterally placed needles (26%).
Optimal "predominantly epidural and/or intraforaminal" flow patterns were more frequent with medial needle placements (75% and 47%) versus lateral placements (17%).
Moderate interrater reliability (kappa 0.61-0.76) was observed for flow pattern classification.

Conclusions:

Medial needle tip positioning during cervical TFESIs is linked to more favorable contrast flow patterns.
Further research is needed to determine the clinical significance of these findings as patient outcomes were not assessed.