1. 2004;7;217-223Evaluation of Lumbar Transforaminal Epidural Injections with Needle Placement and Contrast Flow Patterns: A Prospective, Descriptive Report
   An Original Contribution
   Laxmaiah Manchikanti, MD, Kim A. Cash, RT, Vidyasagar Pampati, MSc, Kim S. Damron, RN, and Carla D. McManus, RN, BSN.

Background: Transforaminal epidural steroid injection is one of the commonly employed modalities of treatment in managing nerve root pain. However, there have been no controlled prospective evaluations of epidural and nerve root contrast distribution patterns and other aspects of fluoroscopically directed lumbosacral transforaminal epidural steroid injections.

Objectives: To evaluate contrast flow patterns and intravascular needle placement of fluoroscopically guided lumbosacral transforaminal epidural injections.

Design: A prospective, observational study.

Methods: A total of 100 consecutive patients undergoing fluoroscopically guided transforaminal epidural steroid injections were evaluated. The contrast flow patterns, ventral or dorsal epidural filling, nerve root filling, C-arm time, and intravascular needle placement were evaluated.

Results: Ventral epidural filling was seen in 88% of the procedures, in contrast to dorsal filling noted in 9% of the procedures. Nerve root filling was seen in 97% of the procedures. Total intravenous placement of the needle was noted in 22% of the procedures, whereas negative flashback and aspiration was noted in 5% of the procedures.

Conclusion: Lumbosacral transforaminal epidural injections, performed under fluoroscopic visualization, provide excellent nerve root filling and ventral epidural filling patterns. However, unrecognized intravascular needle placement with negative flashback or aspiration was noted in 5% of the procedures.

Keywords: Chronic low back pain, nerve root pain, lumbosacral transforaminal epidural injection, fluoroscopy, ventral epidural contrast flow