CT-guided transforaminal epidural steroid injection for discogenic lumbar radiculopathy: influence of contrast dispersion and radiologist's experience on clinical outcome.

Autor: Germann C; Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland. christoph.germann@balgrist.ch., Graf DN; Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland., Fritz B; Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland., Sutter R; Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
Jazyk: angličtina
Zdroj: Skeletal radiology [Skeletal Radiol] 2022 Apr; Vol. 51 (4), pp. 783-793. Date of Electronic Publication: 2021 Aug 12.
DOI: 10.1007/s00256-021-03881-x
Abstrakt: Objective: To investigate the impact of contrast dispersion pattern/location during lumbar CT-guided transforaminal epidural steroid injection (TFESI) and experience of the performing radiologist on therapeutic outcome.
Materials and Methods: In this single-center retrospective cohort study, two observers analyzed contrast dispersion during CT-guided TFESI of 204 patients (age 61.1 ± 14 years) with discogenic unilateral single-level L4 or L5 radiculopathy. The contrast dispersion pattern was classified as "focal," "linear," or "tram-track"; the location was divided into "extraforaminal," "foraminal," or "recessal." Pain was assessed before and 4 weeks after treatment using a numerical rating scale (0, no pain; 10, intolerable pain). Additionally, the patient global impression of change (PGIC) was assessed. The TFESI was performed by musculoskeletal radiologists (experience range: first year of musculoskeletal fellowship training to 19 years). Contrast pattern/location and radiologist's experience were compared between "good responder" (≥ 50% pain reduction) and "poor responder" (< 50%). A p-value < 0.05 was considered to be statistically significant.
Results: Overall, CT-guided TFESI resulted in a substantial pain reduction in 46.6% of patients with discogenic radiculopathy. The contrast dispersion pattern and location had no effect on pain relief (p = 0.75 and p = 0.09) and PGIC (p = 0.70 and p = 0.21) 4 weeks after TFESI. Additionally, the experience of the radiologist had no influence on pain reduction (p = 0.92) or PGIC (p = 0.75). Regarding pre-interventional imaging findings, both the location and grading of nerve compression had no effect on pain relief (p = 0.91 and p = 0.85) and PGIC (p = 0.18 and p = 0.31).
Conclusion: Our results indicate that neither contrast agent dispersion/location nor the experience of the radiologist allows predicting the therapeutic outcome 4 weeks after the procedure.
(© 2021. The Author(s).)
Databáze: MEDLINE
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