Whitacre Needle Reduces the Incidence of Intravascular Uptake in Lumbar Transforaminal Epidural XXXX Injections.

@entity1 @entity1688 @entity1188 @entity158 @entity113 @entity1317 @entity451 @entity479
BACKGROUND: Transforaminal epidural @entity479 injection (TFESI) is a commonly used interventional @entity158 management procedures to treat radicular leg @entity158 . Although most reported complications of TFESI are minor, serious morbidity has also been demonstrated including @entity1188 , @entity451 , and @entity1688 . Suggested mechanisms include @entity1317 or intravascular injection of particulate @entity479 . OBJECTIVE: We compared 2 different needle types, @entity113 , with regard to intravascular injection rate with total procedure time and the amount of radiation during lumbar TFESI. STUDY DESIGN: Prospective, randomized trial. SETTING: An interventional @entity158 management practice in South Korea. METHODS: After Institutional Review Board approval, 149 @entity1 undergoing lumbar TFESI for radicular leg @entity158 were randomly assigned to one of 2 needle groups (Whitacre needle or Quincke type needle). After final confirmation of intravascular injection with digital subtraction angiography, total procedure time and amount of radiation exposure during TFESI were measured. RESULTS: The overall incidence of intravascular injection was 10.4% (28/269). We analyzed the overall incidence of intravascular injection according to the 2 different needle types. The incidence of intravascular injection of the Whitacre needle was 5.4% (8/146), whereas the incidence of intravascular injection of the Quincke needle was 16.2% (20/123). Total procedure time and amount of radiation required to complete the TFESI in the Whitacre and Quincke needle groups was 168.4    57.9 (seconds) and 33.4    15.9 (cGy/cm2), 131.9    46.0 (seconds) and 33.2    15.8 (cGy/cm2), respectively. LIMITATIONS: The physician who performed the TFESI was not blinded to the type of needle for detecting intravascular injection. This study was focused on lumbar TFESI, however, most TFESIs are performed at the L4-5 or L5-S1 level. CONCLUSION: The Whitacre needle had the benefit of reducing the incidence of intravascular injection with minimal differences in technical difficulties and the amount of radiation exposure during lumbar TFESI. KEY WORDS: Transforaminal epidural @entity479 injection, complication, intravascular injection, Whitacre needle, Quincke needle, procedure time, radiation, digital subtraction angiography.
