Track topics on Twitter Track topics that are important to you
Interventional spine procedures are becoming more common. Safety is partly related to proper technique. Injection of steroids and local anesthetics in the vascular space may have serious complications. In addition to safety concerns, if the medication is not delivered to the desired location (epidural space) the injection may not be effective. The purpose of this study is to determine if the incidence of intravascular injection differs between different needle types used during transforaminal epidural injections.
The investigators plan to enroll a total of 500 subjects ( 250 subjects undergoing cervical and 250 subjects undergoing lumbosacral transforaminal epidural injection ) ; patients will have radiculopathies, herniated discs, degenerative discs, and spinal stenosis coming to Stanford for an epidural steroid injection.
To date, no study has reported the comparative incidence of intravascular injection during transforaminal epidural injections with other needle types.
Any patient scheduled by their treating physiatrist or spine surgeon for a transforaminal epidural injection will provide written informed consent before the procedure is conducted. The contents of the consent forms will be used to explain the study to patients. There are no drug treatments associated with the study other than those which are part of the existing treatment plan. There is subject randomization.
Patients with pregnancy, coagulopathy, systemic infection, allergy to contrast dye, mentally disabled or those whom are unable to give informed consent will be excluded from the study.
1. One experienced physician will perform fluoroscopically-guided transforaminal epidural injections. (standard of care)
2. Different types of needle tips will be used en block to allow comparisons between groups of patients who received injections with different needle types.
3. For each injection the final location of the needle tip will be recorded and the dynamic flow of contrast will be observed under live fluoroscopy. The presence or absence of vascular patterns will be recorded. The observed pattern will be recorded as one of the following categories: epidural only, vascular only, or simultaneous epidural and vascular.
4. If a soft tissue injection is initially observe, the needle will be repositioned until one of the above contrast patterns is seen. When a vascular contrast pattern is observe, the needle will be repositioned. Once an epidural pattern is observe alone, the treatment solution will be injected.
5. Analyze data.
All of the procedures for this protocol are standard of care. All data is collected during the procedure. There will be no follow-ups after the procedure.
Observational Model: Cohort, Time Perspective: Prospective
Blunt Coude, Quinke, Chiba, Touhy, Pencil
Stanford University School of Medicine
Not yet recruiting
Published on BioPortfolio: 2014-08-27T03:17:43-0400
The objective of this study was to determine if blunt needle use during cesarean section closure protects against glove perforation and percutaneous injury to the surgeon and surgical assi...
The objective of this study is to evaluate the outcomes of children who have sustained blunt renal injury and to evaluate our current bed rest protocol. The variables of concern are readmi...
This study will assess the analgesic efficacy of DSG 1% compared to placebo in the reduction of the pain associated with acute blunt trauma injuries.
Virtual Reality allows the integration of both cognitive and motor rehabilitation in a more ecologically valid context. The purpose of this study is to determine whether this methodology h...
The researchers are trying to identify molecular mechanisms that control spine deformity and degenerative changes that can be used for therapeutic strategies.
It has been proven that statin can protect synovial joints from developing osteoarthritis through its anti-inflammatory effects. However, studies on the effect of statins on spinal degenerative joint ...
Introduction: Blunt renal trauma (BRT) is a dangerous medical condition. The aim: Analysis of effectiveness of conservative and expectant treatment tactics under ultrasound and CT monitoring in patien...
Major blunt chest injury usually leads to the development of retained hemothorax and pneumothorax, and needs further intervention. However, since blunt chest injury may be combined with blunt head inj...
This study aimed to determine the incidence and analyze trends related to spinal diseases based on a national database in the Republic of Korea (ROK) and to elucidate the healthcare burden that will s...
To introduce and evaluate the use of stable distributions as a methodology to quantify the behavior of proton pencil beams in a medium.
Pathologic conditions which feature SPINAL CORD damage or dysfunction, including disorders involving the meninges and perimeningeal spaces surrounding the spinal cord. Traumatic injuries, vascular diseases, infections, and inflammatory/autoimmune processes may affect the spinal cord.
Reduced blood flow to the spinal cord which is supplied by the anterior spinal artery and the paired posterior spinal arteries. This condition may be associated with ARTERIOSCLEROSIS, trauma, emboli, diseases of the aorta, and other disorders. Prolonged ischemia may lead to INFARCTION of spinal cord tissue.
Inflammation of the spinal cord. Relatively common etiologies include infections; AUTOIMMUNE DISEASES; SPINAL CORD; and ischemia (see also SPINAL CORD VASCULAR DISEASES). Clinical features generally include weakness, sensory loss, localized pain, incontinence, and other signs of autonomic dysfunction.
Severe or complete loss of motor function in all four limbs which may result from BRAIN DISEASES; SPINAL CORD DISEASES; PERIPHERAL NERVOUS SYSTEM DISEASES; NEUROMUSCULAR DISEASES; or rarely MUSCULAR DISEASES. The locked-in syndrome is characterized by quadriplegia in combination with cranial muscle paralysis. Consciousness is spared and the only retained voluntary motor activity may be limited eye movements. This condition is usually caused by a lesion in the upper BRAIN STEM which injures the descending cortico-spinal and cortico-bulbar tracts.
Pathological processes involving any of the BLOOD VESSELS feeding the SPINAL CORD, such as the anterior and paired posterior spinal arteries or their many branches. Disease processes may include ATHEROSCLEROSIS; EMBOLISM; and ARTERIOVENOUS MALFORMATIONS leading to ISCHEMIA or HEMORRHAGE into the spinal cord (hematomyelia).
Blood is a specialized bodily fluid that delivers necessary substances to the body's cells (in animals) – such as nutrients and oxygen – and transports waste products away from those same cells. In vertebrates, it is composed of blo...
Pharmacy is the science and technique of preparing as well as dispensing drugs and medicines. It is a health profession that links health sciences with chemical sciences and aims to ensure the safe and effective use of pharmaceutical drugs. The scope of...
Spinal Cord Disorders
The spinal cord is a bundle of nerves that runs down the middle of the back which carry signals back and forth between the body and brain. It is protected by vertebrae, which are the bone disks that make up the spine. An accident that damages the verte...