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The Role of Spectral Tissue Sensing During Lumbar Transforaminal Epidural Injection
  1. Andrea J.R. Balthasar, MD*,
  2. Gerald W. Lucassen, PhD,
  3. Micha Sommer, MD, PhD*,
  4. Marjolein van der Voort, PhD,
  5. Geert Gijsbers, PhD,
  6. Carsten W.K.P. Arnoldussen, MD,
  7. Alfons Kessel, MSc§,
  8. Stefan Roggeveen, Ir,
  9. Arno Lataster, MSc and
  10. Maarten van Kleef, MD, PhD*,
  1. From the *Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht; †Philips Healthcare, Best; Departments of ‡Radiology and §Clinical Epidemiology & Medical Technology Assessment, Maastricht University Medical Center; and ‖Department of Anatomy and Embryology, Maastricht University, Maastricht; and ¶Department of Anesthesiology, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
  1. Address correspondence to: Andrea J.R. Balthasar, MD, Department of Anesthesiology Pain Medicine, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, the Netherlands (e-mail: a.balthasar{at}


Abstract Spectral tissue sensing (STS) exploits the scattering and absorption of light by tissue. The main objective of the present study was to determine whether STS can discriminate between correct and incorrect placement of the needle tip during lumbar transforaminal epidural injection. This was a single-blind prospective observational study in 30 patients with lumbar radicular pain scheduled for lumbar transforaminal epidural injection. Spectral tissue sensing data from the needle tip were acquired along the needle trajectory at 4 predefined measurement points and compared with ultrasound, fluoroscopy, and digital subtraction angiography images. Spectral tissue sensing data contained the full spectra. The lipid and hemoglobin content at the different measurement points was also calculated, and partial least-squares discriminant analysis was used to estimate the sensitivity and specificity of STS. Spectral tissue sensing identified correct needle placement with a sensitivity of 57% and a specificity of 82%, and intraforaminal versus extraforaminal locations were identified with a sensitivity of 80% and a specificity of 71%.

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  • Institutional funding for the study was received from Philips Electronics Nederland B.V. acting through Philips Research, Eindhoven, the Netherlands.

    The authors declare no conflict of interest.

    Trial registration: Identifier: NCT01476709. Title: Photonic Needle and Intraforaminal Epidural Injection (Sleeve)—Observational Study in Humans