Effect of Needle Type on Intravascular Injection in Transforaminal Epidural Injection: a Meta-analysis

Overview

Journal Korean J Pain

Date 2019 Jan 24

PMID 30671202

Citations 3

Authors

Jae Yun Kim

Soo Nyoung Kim

Chulmin Park

Ho Young Lim

Jae Hun Kim

Affiliations

Soon will be listed here.

Abstract

Background: Lumbosacral transforaminal epidural injection (TFEI) is an effective treatment for spinal disease. However, TFEI may have several types of complications, some of which can be attributed to intravascular injection. We reviewed studies to compare the intravascular injection rate among different needle types.

Methods: We searched the literature for articles on the intravascular injection rate among different needle types used in TFEI. The search was performed using PubMed, MEDLINE, the Cochrane Library, EMBASE, and Web of Science.

Results: A total of six studies comprising 2359 patients were identified. Compared with the Quincke needle, the Whitacre needle reduced the intravascular injection rate (OR = 0.57, 95% CI = [0.44-0.73], < 0.001). However, compared with the Quincke needle, the Chiba needle did not reduce the intravascular injection rate (OR = 0.80, 95% CI = [0.44-1.45], = 0.46). In one study, the intravascular injection rate using a blunt-tip needle was lower than that using a sharp needle. In another study, the Whitacre and the blunt-tip needle have similar intravascular injection rates, while, the catheter-extension needle showed a reduced intravascular injection rate.

Conclusions: This meta-analysis showed that the Whitacre needle reduced the intravascular injection rate as compared with the Quincke needle, but failed to establish that the Chiba needle can decrease the intravascular injection rate in TFEI. Moreover, the blunt-tip needle can reduce the intravascular injection rate compared with the Quincke needle, and the catheter-extension needle can reduce the intravascular injection rate compared with the Whitacre and the blunt-tip needle.

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References

Botwin K, Gruber R, Bouchlas C, Freeman T, Slaten W . Complications of fluoroscopically guided transforaminal lumbar epidural injections. Arch Phys Med Rehabil. 2000; 81(8):1045-50. DOI: 10.1053/apmr.2000.7166. View

Furman M, OBrien E, Zgleszewski T . Incidence of intravascular penetration in transforaminal lumbosacral epidural steroid injections. Spine (Phila Pa 1976). 2000; 25(20):2628-32. DOI: 10.1097/00007632-200010150-00014. View

Reitman C, Watters 3rd W . Subdural hematoma after cervical epidural steroid injection. Spine (Phila Pa 1976). 2002; 27(6):E174-6. DOI: 10.1097/00007632-200203150-00022. View

Furman M, Giovanniello M, OBrien E . Incidence of intravascular penetration in transforaminal cervical epidural steroid injections. Spine (Phila Pa 1976). 2003; 28(1):21-5. DOI: 10.1097/00007632-200301010-00007. View

Jasper J . Role of digital subtraction fluoroscopic imaging in detecting intravascular injections. Pain Physician. 2006; 6(3):369-72. View

Lavi R, Yarnitsky D, Yernitzky D, Rowe J, Weissman A, Segal D . Standard vs atraumatic Whitacre needle for diagnostic lumbar puncture: a randomized trial. Neurology. 2006; 67(8):1492-4. DOI: 10.1212/01.wnl.0000240054.40274.8a. View

Heavner J, Racz G, Jenigiri B, Lehman T, Day M . Sharp versus blunt needle: a comparative study of penetration of internal structures and bleeding in dogs. Pain Pract. 2006; 3(3):226-31. DOI: 10.1046/j.1533-2500.2003.03027.x. View

Boswell M, Trescot A, Datta S, Schultz D, Hansen H, Abdi S . Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician. 2007; 10(1):7-111. View

Scanlon G, Moeller-Bertram T, Romanowsky S, Wallace M . Cervical transforaminal epidural steroid injections: more dangerous than we think?. Spine (Phila Pa 1976). 2007; 32(11):1249-56. DOI: 10.1097/BRS.0b013e318053ec50. View

10.

Buenaventura R, Datta S, Abdi S, Smith H . Systematic review of therapeutic lumbar transforaminal epidural steroid injections. Pain Physician. 2009; 12(1):233-51. View

11.

Kim D, Han K, Kim C, Chae Y . Intravascular flow patterns in transforaminal epidural injections: a comparative study of the cervical and lumbar vertebral segments. Anesth Analg. 2009; 109(1):233-9. DOI: 10.1213/ane.0b013e3181a826db. View

12.

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009; 151(4):W65-94. DOI: 10.7326/0003-4819-151-4-200908180-00136. View

13.

Eckel T, Bartynski W . Epidural steroid injections and selective nerve root blocks. Tech Vasc Interv Radiol. 2009; 12(1):11-21. DOI: 10.1053/j.tvir.2009.06.004. View

14.

Kennedy D, Dreyfuss P, Aprill C, Bogduk N . Paraplegia following image-guided transforaminal lumbar spine epidural steroid injection: two case reports. Pain Med. 2009; 10(8):1389-94. DOI: 10.1111/j.1526-4637.2009.00728.x. View

15.

Smuck M, Yu A, Tang C, Zemper E . Influence of needle type on the incidence of intravascular injection during transforaminal epidural injections: a comparison of short-bevel and long-bevel needles. Spine J. 2010; 10(5):367-71. DOI: 10.1016/j.spinee.2009.12.018. View

16.

Lee M, Yang K, Kim Y, Jung H, Lim S, Moon D . Accuracy of live fluoroscopy to detect intravascular injection during lumbar transforaminal epidural injections. Korean J Pain. 2010; 23(1):18-23. PMC: 2884208. DOI: 10.3344/kjp.2010.23.1.18. View

17.

Wolter T, Knoeller S, Berlis A, Hader C . CT-guided cervical selective nerve root block with a dorsal approach. AJNR Am J Neuroradiol. 2010; 31(10):1831-6. PMC: 7964002. DOI: 10.3174/ajnr.A2230. View

18.

Murthy N, Maus T, Behrns C . Intraforaminal location of the great anterior radiculomedullary artery (artery of Adamkiewicz): a retrospective review. Pain Med. 2010; 11(12):1756-64. DOI: 10.1111/j.1526-4637.2010.00948.x. View

19.

Desai M, Shah B, Sayal P . Epidural contrast flow patterns of transforaminal epidural steroid injections stratified by commonly used final needle-tip position. Pain Med. 2011; 12(6):864-70. DOI: 10.1111/j.1526-4637.2011.01119.x. View

20.

Kloth D, Calodney A, Derby R, Lagattuta F, ONeill C, Yurth E . Improving the safety of transforaminal epidural steroid injections in the treatment of cervical radiculopathy. Pain Physician. 2011; 14(3):285-93. View