Epidurography and therapeutic epidural injections: Technical considerations and experience with 5334 cases

BACKGROUND AND PURPOSE: Even in experienced hands, blind epidural steroid i njections result in inaccurate needle placement in up to 30% of cases. The use of fluoroscopy and radiologic contrast material provides confirmation o f accurate needle placement within the epidural space. We describe our tech nique and experience with contrast epidurography and therapeutic epidural s teroid injections, and review the frequency of systemic and neurologic comp lications. METHODS: Epidural steroid injections were performed in 5489 consecutive out patients over a period of 51/2 years by three procedural neuroradiologists, In 155 cases (2.8%), the injections were done without contrast material ow ing to either confirmed or suspected allergy. The remaining 5334 injections were performed after epidurography through the same needle. Patients and r eferring clinicians were instructed to contact us first regarding complicat ions or any problem potentially related to the injection. In addition, the referring clinicians' offices were instructed to contact us regarding any c onceivable procedure-related complications. RESULTS: Only 10 patients in the entire series required either oral (n = 5) or intravenous (n = 5) sedation. Four complications (0.07%) required eithe r transport to an emergency room (n = 2) or hospitalization (n = 2), None o f the complications required surgical intervention, and all were self-limit ed with regard to symptoms and imaging manifestations. Fluoroscopic needle placement and epidurography provided visual confirmation of accurate needle placement, distribution of the injectate, and depiction of epidural space disease. CONCLUSION: Epidurography in conjunction with epidural steroid injections p rovides for safe and accurate therapeutic injection and is associated with an exceedingly low frequency of untoward sequelae, It can be performed safe ly on an outpatient basis and does not require sedation or special monitori ng.