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Ultrasound-Assisted Lumbar Interlaminar Epidural Dye Injection and Evaluation of Its Distribution by Anatomical Dissection

Background: Epidural steroid injections are frequently used to treat lumbar radicular pain. However, the spread of a solute in the epidural space needs further elucidation. We aimed at assessing the distribution of green dye in the epidural space after lumbar epidural injection on cadavers. Methods:...

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Autores principales: Evansa, Irina, Krumina, Angelika, Simonova, Anna, Dzabijeva, Viktorija, Fedorovica, Svetlana, Hadunkina, Alla, Zlobina, Natalja, Vabels, Grigorijs, Strike, Eva, Viksna, Ludmila, Vanags, Indulis
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422940/
https://www.ncbi.nlm.nih.gov/pubmed/30915336
http://dx.doi.org/10.3389/fmed.2019.00049
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author Evansa, Irina
Krumina, Angelika
Simonova, Anna
Dzabijeva, Viktorija
Fedorovica, Svetlana
Hadunkina, Alla
Zlobina, Natalja
Vabels, Grigorijs
Strike, Eva
Viksna, Ludmila
Vanags, Indulis
author_facet Evansa, Irina
Krumina, Angelika
Simonova, Anna
Dzabijeva, Viktorija
Fedorovica, Svetlana
Hadunkina, Alla
Zlobina, Natalja
Vabels, Grigorijs
Strike, Eva
Viksna, Ludmila
Vanags, Indulis
author_sort Evansa, Irina
collection PubMed
description Background: Epidural steroid injections are frequently used to treat lumbar radicular pain. However, the spread of a solute in the epidural space needs further elucidation. We aimed at assessing the distribution of green dye in the epidural space after lumbar epidural injection on cadavers. Methods: We performed ultrasound-guided injections of green dye between lumbar vertebrae 4 and 5 in 24 cadavers. The cadavers were randomly divided into group A and B according to the volume of injected dye; 3 ml in group A (n = 13) and 6 ml in group B (n = 11). Accuracy of the needle insertion and patterns and distributions of the spread were compared between the groups. After local dissection, we examined the spread of dye in dorsal and ventral epidural spaces and presented the distribution as whole numbers and quartiles of intervertebral segments. Mann-Whitney U Test was used to compare distribution of dye spread between groups A and B. Wilcoxon Signed-Rank Test was used to compare the spread of dye in cranial and caudal direction within the group. We considered P < 0.05 as significant. Results: Data were obtained from all 24 cadavers. Median levels of dorsal cranial dye distribution in groups A and B were 2 and 4 (P = 0.02), respectively. In the dorsal caudal−2 and 2, respectively (P = 0.04). In the ventral epidural space cranial dye spread medians were−0 and 2 in groups, respectively (P = 0.04). Ventral caudal spread was 0 and 1, respectively (P = 0.03). We found a significant difference between cranial and caudal dye distribution in group B (P < 0.05). In group A the dye spread was bilateral. In group B cranial and caudal dye spread was observed. Conclusions: Ventral dye flow was observed in 50% of injections. Bilateral spread of dye occurred in 63%, and more often in group A. Cranial spread was slightly higher than caudal spread in group A despite a smaller injected volume, and significantly higher in group B following a larger volume.
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spelling pubmed-64229402019-03-26 Ultrasound-Assisted Lumbar Interlaminar Epidural Dye Injection and Evaluation of Its Distribution by Anatomical Dissection Evansa, Irina Krumina, Angelika Simonova, Anna Dzabijeva, Viktorija Fedorovica, Svetlana Hadunkina, Alla Zlobina, Natalja Vabels, Grigorijs Strike, Eva Viksna, Ludmila Vanags, Indulis Front Med (Lausanne) Medicine Background: Epidural steroid injections are frequently used to treat lumbar radicular pain. However, the spread of a solute in the epidural space needs further elucidation. We aimed at assessing the distribution of green dye in the epidural space after lumbar epidural injection on cadavers. Methods: We performed ultrasound-guided injections of green dye between lumbar vertebrae 4 and 5 in 24 cadavers. The cadavers were randomly divided into group A and B according to the volume of injected dye; 3 ml in group A (n = 13) and 6 ml in group B (n = 11). Accuracy of the needle insertion and patterns and distributions of the spread were compared between the groups. After local dissection, we examined the spread of dye in dorsal and ventral epidural spaces and presented the distribution as whole numbers and quartiles of intervertebral segments. Mann-Whitney U Test was used to compare distribution of dye spread between groups A and B. Wilcoxon Signed-Rank Test was used to compare the spread of dye in cranial and caudal direction within the group. We considered P < 0.05 as significant. Results: Data were obtained from all 24 cadavers. Median levels of dorsal cranial dye distribution in groups A and B were 2 and 4 (P = 0.02), respectively. In the dorsal caudal−2 and 2, respectively (P = 0.04). In the ventral epidural space cranial dye spread medians were−0 and 2 in groups, respectively (P = 0.04). Ventral caudal spread was 0 and 1, respectively (P = 0.03). We found a significant difference between cranial and caudal dye distribution in group B (P < 0.05). In group A the dye spread was bilateral. In group B cranial and caudal dye spread was observed. Conclusions: Ventral dye flow was observed in 50% of injections. Bilateral spread of dye occurred in 63%, and more often in group A. Cranial spread was slightly higher than caudal spread in group A despite a smaller injected volume, and significantly higher in group B following a larger volume. Frontiers Media S.A. 2019-03-12 /pmc/articles/PMC6422940/ /pubmed/30915336 http://dx.doi.org/10.3389/fmed.2019.00049 Text en Copyright © 2019 Evansa, Krumina, Simonova, Dzabijeva, Fedorovica, Hadunkina, Zlobina, Vabels, Strike, Viksna and Vanags. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Evansa, Irina
Krumina, Angelika
Simonova, Anna
Dzabijeva, Viktorija
Fedorovica, Svetlana
Hadunkina, Alla
Zlobina, Natalja
Vabels, Grigorijs
Strike, Eva
Viksna, Ludmila
Vanags, Indulis
Ultrasound-Assisted Lumbar Interlaminar Epidural Dye Injection and Evaluation of Its Distribution by Anatomical Dissection
title Ultrasound-Assisted Lumbar Interlaminar Epidural Dye Injection and Evaluation of Its Distribution by Anatomical Dissection
title_full Ultrasound-Assisted Lumbar Interlaminar Epidural Dye Injection and Evaluation of Its Distribution by Anatomical Dissection
title_fullStr Ultrasound-Assisted Lumbar Interlaminar Epidural Dye Injection and Evaluation of Its Distribution by Anatomical Dissection
title_full_unstemmed Ultrasound-Assisted Lumbar Interlaminar Epidural Dye Injection and Evaluation of Its Distribution by Anatomical Dissection
title_short Ultrasound-Assisted Lumbar Interlaminar Epidural Dye Injection and Evaluation of Its Distribution by Anatomical Dissection
title_sort ultrasound-assisted lumbar interlaminar epidural dye injection and evaluation of its distribution by anatomical dissection
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422940/
https://www.ncbi.nlm.nih.gov/pubmed/30915336
http://dx.doi.org/10.3389/fmed.2019.00049
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