Archives of physical medicine and rehabilitation · 2003
Complications of fluoroscopically guided interlaminar cervical epidural injections.
СтатьяНазвание и аннотация: Перевод в очереди
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Botwin Kenneth P, Castellanos Ramon, Rao Sanjiv, Hanna Ashraf F, Torres-Ramos Francisco M, Gruber Robert D, Bouchlas Constantine G, Fuoco Glenn S
Аннотация
OBJECTIVES: To assess the incidence of complications of fluoroscopically guided interlaminar cervical epidural injections.
DESIGN: A retrospective cohort design study.
SETTING: A multidisciplinary spine care center.
PARTICIPANTS: One hundred fifty-seven consecutive patients with cervical radicular pain caused by cervical spondylosis or herniated nucleus pulposus confirmed by magnetic resonance imaging or computed tomography scanning.
INTERVENTIONS: Fluoroscopically guided interlaminar cervical epidural injections were performed at the C7-T1 or C6-7 level using an 18-gauge, 9-mm Tuohy needle with 2mL of 1% lidocaine (Xylocaine) and 80-mg of triamcinolone acetonide (Kenalog). All injections were performed consecutively over a 12-month period by 1 of 5 physicians.
MAIN OUTCOME MEASURES: An independent observer reviewed medical charts, which included a 24-hour postprocedure telephone call by an ambulatory surgery center nurse who asked a standardized questionnaire about complications after the injections. Also reviewed were physician notes regarding office follow-up consultations 3 weeks or less after the injections and epidurograms.
RESULTS: The charts of 157 patients, who received 345 injections, were reviewed. Complications per injection included 23 increased neck pain (6.7%), 16 transient nonpositional headaches that resolved within 24 hours (4.6%), 6 episodes of insomnia the night of the injection (1.7%), 6 vasovagal reactions (1.7%), 5 facial flushing (1.5%), 1 fever the night of the procedure (0.3%), and 1 dural puncture (0.3%). The incidence of all complications per injection was 16.8%.
CONCLUSIONS: Because all complications resolved without morbidity and no patient required hospitalization, fluoroscopically guided interlaminar cervical epidural injections may be a safe procedure for use in patients with cervical radicular pain.
DESIGN: A retrospective cohort design study.
SETTING: A multidisciplinary spine care center.
PARTICIPANTS: One hundred fifty-seven consecutive patients with cervical radicular pain caused by cervical spondylosis or herniated nucleus pulposus confirmed by magnetic resonance imaging or computed tomography scanning.
INTERVENTIONS: Fluoroscopically guided interlaminar cervical epidural injections were performed at the C7-T1 or C6-7 level using an 18-gauge, 9-mm Tuohy needle with 2mL of 1% lidocaine (Xylocaine) and 80-mg of triamcinolone acetonide (Kenalog). All injections were performed consecutively over a 12-month period by 1 of 5 physicians.
MAIN OUTCOME MEASURES: An independent observer reviewed medical charts, which included a 24-hour postprocedure telephone call by an ambulatory surgery center nurse who asked a standardized questionnaire about complications after the injections. Also reviewed were physician notes regarding office follow-up consultations 3 weeks or less after the injections and epidurograms.
RESULTS: The charts of 157 patients, who received 345 injections, were reviewed. Complications per injection included 23 increased neck pain (6.7%), 16 transient nonpositional headaches that resolved within 24 hours (4.6%), 6 episodes of insomnia the night of the injection (1.7%), 6 vasovagal reactions (1.7%), 5 facial flushing (1.5%), 1 fever the night of the procedure (0.3%), and 1 dural puncture (0.3%). The incidence of all complications per injection was 16.8%.
CONCLUSIONS: Because all complications resolved without morbidity and no patient required hospitalization, fluoroscopically guided interlaminar cervical epidural injections may be a safe procedure for use in patients with cervical radicular pain.
Предметные рубрики MeSH
AdultAge DistributionAgedCervical VertebraeChi-Square DistributionFemaleFeverFluoroscopyHeadacheHumansIncidenceInjections, EpiduralIntervertebral Disc DisplacementLidocaineMagnetic Resonance ImagingMaleMiddle AgedMorbidityNeck PainPain MeasurementRadiography, InterventionalRetrospective StudiesSleep Initiation and Maintenance DisordersSpinal OsteophytosisSyncope, VasovagalTomography, X-Ray ComputedTreatment OutcomeTriamcinolone Acetonide