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Access routes and reported decision criteria for lumbar epidural drug injections: a systematic literature review


Andreisek, Gustav; Jenni, Maja; Klingler, Dominic; Wertli, Maria; Elliott, Marina; Ulbrich, Erika J; Winklhofer, Sebastian; Steurer, Johann (2013). Access routes and reported decision criteria for lumbar epidural drug injections: a systematic literature review. Skeletal Radiology, 42(12):1683-1692.

Abstract

PURPOSE: To review lumbar epidural drug injection routes in relation to current practice and the reported criteria used for selecting a given approach.
MATERIAL AND METHODS: This was a HIPPA-compliant study. Employing a systematic search strategy, the MEDLINE and EMBASE databank as well as the Cochrane Library were searched for studies on epidural drug injections. The following data were noted: access route, level of injection, use of image guidance, and types and doses of injected drugs. Justifications for the use of a particular route were also noted. Data were presented using descriptive statistics.
RESULTS: A total of 1,211 scientific studies were identified, of which 91 were finally included (7.5 %). The interlaminar access route was used in 44 of 91 studies (48.4 %), the transforaminal in 37 of 91 studies (40.7 %), and the caudal pathway in 26 of 91 studies (28.6 %). The caudal pathway was favored in the older studies whereas the transforaminal route was favored in recent studies. Decision criteria related to correct needle placement, concentration of injected drug at lesion site, technical complexity, costs, and potential complications. Injection was usually performed on the level of the lesion using local anesthetics (71 of 91 studies, 78.0 %), steroids (all studies) and image guidance (71 of 91 studies, 78 %).
CONCLUSIONS: The most commonly used access routes for epidural drug injection are the interlaminar and transforaminal pathways at the level of the pathology. Transforaminal routes are being performed with increasing frequency in recent years.

Abstract

PURPOSE: To review lumbar epidural drug injection routes in relation to current practice and the reported criteria used for selecting a given approach.
MATERIAL AND METHODS: This was a HIPPA-compliant study. Employing a systematic search strategy, the MEDLINE and EMBASE databank as well as the Cochrane Library were searched for studies on epidural drug injections. The following data were noted: access route, level of injection, use of image guidance, and types and doses of injected drugs. Justifications for the use of a particular route were also noted. Data were presented using descriptive statistics.
RESULTS: A total of 1,211 scientific studies were identified, of which 91 were finally included (7.5 %). The interlaminar access route was used in 44 of 91 studies (48.4 %), the transforaminal in 37 of 91 studies (40.7 %), and the caudal pathway in 26 of 91 studies (28.6 %). The caudal pathway was favored in the older studies whereas the transforaminal route was favored in recent studies. Decision criteria related to correct needle placement, concentration of injected drug at lesion site, technical complexity, costs, and potential complications. Injection was usually performed on the level of the lesion using local anesthetics (71 of 91 studies, 78.0 %), steroids (all studies) and image guidance (71 of 91 studies, 78 %).
CONCLUSIONS: The most commonly used access routes for epidural drug injection are the interlaminar and transforaminal pathways at the level of the pathology. Transforaminal routes are being performed with increasing frequency in recent years.

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6 citations in Web of Science®
5 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
04 Faculty of Medicine > University Hospital Zurich > Clinic and Policlinic for Internal Medicine
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2013
Deposited On:19 Sep 2013 08:15
Last Modified:05 Apr 2016 16:59
Publisher:Springer
ISSN:0364-2348
Publisher DOI:https://doi.org/10.1007/s00256-013-1713-5
PubMed ID:23995263

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