S1 Transforaminal Injection and Vascular Incidence

Study Overview
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Brief Summary
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Intravascular incidence during S1 transforaminal injection is known to be higher than lumbar injection. Its incidence is reported to be 15 25%. This study was aimed to see if there is any benefit of reducing the intravasuclar injection rate when S1 transforaminal injection was performed by different fluorosopic approach.

Detailed Description
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Fluorosocpically guided transforaminal epidural steroid injection is a popular interventional procedure that is effective in radicular pain conditions such as herniated interverebral disc, spinal stenosis and failed back surgery syndrome. The incidence of inadvertent intravascular needle injection during lumbar transforaminal injection is reported as from 9.9% to 30.8%. In particular, S1 intravascular injection rate is more frequent than at the lumbar level. Previous study reported that guiding the needle toward the S1 foramen using the S1 scotty dog image as a bony landmark, not in the classic way, but in an oblique fluoroscopic view, during L5 and S1 transforaminal epidural steroid injection, can save procedure time and reduce the risk of radiation exposure. In this stidy, the investigators aimed to compare the incidence of intravascular injection rate by anteroposterior and oblique view approaches for S1 transforaminal epidural steroid injection. In addition, the investigators also compared the procedure time and radiation exposure between two approach method.

Official Title
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Comparison of Intravascular Incidence With Different Fluoroscopic Approach Method During S1 Trasnforaminal Injection

Conditions
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Inadvertent Arterial Puncture

Intervention / Treatment
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* Procedure: tranforaminal epidural injection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: spinal stenosis herniated intervertebral disc failed back surgery syndrome Exclusion Criteria: coagulopathy infection

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: S1 transforaminal injection with oboique view<br>S1 transforaminal injection with oblique fluoroscopic view | Procedure: tranforaminal epidural injection<br>* tranforaminal epidural injection which is performed by fluoroscopic guidance<br>|
| Active Comparator: S1 transforaminal injection with AP view<br>S1 transforaminal injection with anteroposterior fluoroscopic view | Procedure: tranforaminal epidural injection<br>* tranforaminal epidural injection which is performed by fluoroscopic guidance<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| intravascular incidence | intravascular injection rate | 15 minutes after the completion of the intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| procedure time | procedure time | 15 minutes after the completion of the intervention | 
| radiation dose | radiation dose | 15 minutes after the completion of the intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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intravascular injection transforaminal injection