| 제목 |
Needle entry angle to prevent carotid sheath injury for cervical TFESI |
| 소속 |
CHA Bundang Medical Center, CHA University, Department of Rehabilitation Medicine1, CHA University, Rehabilitation and Regeneration Research Center2, CHA Bundang Medical Center, CHA University, Department of Radiology3 |
| 저자 |
Jaewoo Choi1,2*, Du Hoe Ha3, Shinyoung Kwon1,2, Youngsu Jung1,2, Junghoon Yu1,2, MinYoung Kim1,2, Kyunghoon Min1,2† |
Background: Cervical Transforaminal epidural steroid injection (TFESI) is associated with the risk of the spinal cord or brain infarction. Although most concerns have been focused on the injection route to prevent injury of vertebral artery, there was no previous study for needle entry angle mainly regarding the carotid sheath. This study aims to suggest the rotation angles of fluoroscopy to bypass the carotid sheath according to vertebral levels for cervical TFESI.
Methods: From January 2009 to October 2017, patients who underwent cervical spine magnetic resonance image (MRI) were analyzed. In the axial sections of cervical spine MRI, three angles to the vertical line were measured (α: angle not to insult carotid sheath, β: angle for the conventional TFESI, γ: angle not to penetrate carotid artery). (Fig. 1)
Results: α angles tended to increase for the upper cervical levels (C6-7: 53.3°, C5-6: 65.2°, C4-5: 75.3°, C3-4: 82.3°). Otherwise, β angles for conventional TFESI showed a constant value of 45 to 47 degrees (C6-7: 47.5°, C5-6: 47.4°, C4-5: 45.7°, C3-4: 45.0°). γ angles increase as the higher cervical levels as α angles (C6-7: 25.2°, C5-6: 33.6°, C4-5: 43.0°, C3-4: 56.2°). (Fig. 2)
Conclusions: The risk of penetrating injury of major vessels in carotid sheath tends to be higher at the upper cervical level. Considering the angle to avoid the carotid vessels in an axial section of CT or MRI in addition to vertebral artery might contribute to safe TFESI procedures. |
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Figure 1. Measurement of needle entry angle
Figure 2. The measured value of α angle, β angle and γ angle
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