Ventral epidural filling technique in interlaminar epidural steroid injection.

Abstract

STUDY DESIGN: A retrospective case-control study.

OBJECTIVE: To evaluate the safety and efficacy of the ventral epidural filling technique in lumbar interlaminar epidural steroid injection (ESI).

SUMMARY OF BACKGROUND DATA: The ventral epidural space can be a preferred target in ESI because it contains many spinal pain generators. However, there have been few studies regarding the ventral epidural space filling technique in interlaminar ESI.

METHODS: This study involved a retrospective analysis of 150 consecutive patients treated with the ventral epidural filling technique in interlaminar ESI (ventral ESI) and a control cohort of 150 consecutive patients treated with the dorsal epidural filling technique in interlaminar ESI (conventional ESI). The visual analogue scale for leg pain, the visual analogue scale for back pain, and the Oswestry Disability Index were compared at preinjection and 2 weeks, 6 weeks, 6 months, and 1 year postinjection. The groups were compared with regard to repeated injection or surgery within 1 year after the initial procedure. The fluoroscopic time and the procedure-related complications including severe pain (visual analogue scale score>7) during injection, dural puncture (subdural contrast spread), headache, neurological symptoms, and infection were also compared.

RESULTS: There were no significant differences in leg pain, back pain, or Oswestry Disability Index improvement at each visit between the ventral ESI group and the conventional ESI group (all P>0.05). The numbers of repeat injections and surgical procedures were not significantly different between 2 groups (P=0.262 and 0.385, respectively). There were no significant differences in severe pain at injection (P=0.326), dural puncture (P=0.428), headache (P=0.393), neurological symptom (P=0.419), or infection (P=0.500) between the 2 groups. The fluoroscopic time was significantly shorter in ventral than in conventional ESI (P<0.000).

CONCLUSION: The ventral epidural filling technique can be performed safely and more easily during lumbar interlaminar ESI. The clinical results and procedure-related complications with this technique were comparable with those seen with conventional interlaminar ESI.

LEVEL OF EVIDENCE: 3.