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Correlation between epidural space depth measured with ultrasound and MRI compared to clinical loss of resistance when performing lumbar epidural steroid injection
  1. Naileshni Singh1,
  2. Scott Pritzlaff1,
  3. Barry Bautista2,
  4. Charley Yan2,
  5. Machelle D Wilson3,
  6. Jennifer Chang4 and
  7. Scott M Fishman1
  1. 1Department of Anesthesiolgy and Pain Medicine, University of California Davis, Sacramento, California, USA
  2. 2School of Medicine, University of California Davis, Sacramento, California, USA
  3. 3Public Health Sciences, Division of Biostatistics, University of California Davis, School of Medicine, Sacramento, California, USA
  4. 4Department of Radiology, University of California San Diego, La Jolla, California, USA
  1. Correspondence to Dr Naileshni Singh, Anesthesiology and Pain Medicine, University of California Davis, Sacramento, California, USA; naisingh{at}ucdavis.edu

Abstract

Background This prospective study assessed the accuracy of MRI and ultrasound (US) measurements as a preprocedural assessment tool for predicting clinical loss of resistance depth (CLORD) during fluoroscopy-guided lumbar epidural steroid injections (ESIs).

Materials and methods Sixty patients enrolled received lumbar ESIs at an academic chronic pain clinic. The MRI measurement calculated the distance between the skin and the posterior epidural space, while US measurements included transverse and parasagittal oblique views of the interlaminar space. The epidural space measurements were compared with the CLORD during the performance of the prone epidural injections. The differences in measurements were analyzed using two one-sided tests for equivalency with a 0.5 equivalency margin. The intraclass correlation coefficients between CLORD and the imaging modalities were estimated using mixed effects models.

Results MRI was equivalent to CLORD with a mean difference of –0.2 cm (95% CI –0.39 to –0.11). US transverse and US parasagittal oblique measurements were not equivalent to and underestimated CLORD with mean differences of –0.98 cm (90% CI –1.8 to –0.77) and –0.79 cm (90% CI −1.0 to −5.9), respectively. The intraclass correlation coefficients between MRI and CLORD were the highest at 0.85, compared with 0.65 and 0.73 for transverse and parasagittal oblique US views, respectively.

Conclusions MRI measurements are preferable over US for preprocedural assessment of patients receiving lumbar ESIs for predicting CLORD.

  • back pain
  • injections, spinal
  • pain management
  • chronic pain

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Twitter @ScottPritzlaff

  • Contributors Identified need of study: NS, SMF. Conception and design: NS, SP, BB, CY, SMF. Recruiting subjects: NS, SP, BB, CY. Acquisition of data: NS, SP, BB, CY. Analysis and interpretation of data: NS, SP, BB, CY, MDW, JC, SMF. Drafting the article: NS, SP, BB, CY, MDW, JC, SMF. Revision for intellectual content: NS, SP, MDW, JC, SMF. Final approval of completed article and guarantor: NS.

  • Funding Sacramento Region Community Foundation, The National Center for Advancing Translational Sciences, National Institutes of Health, supported the project described through grant number UL1 TR001860. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

  • Competing interests NS: none. SP: SPR Therapeutics, Nalu Medical, and Bioventus (Consultant); Nevro, Medtronic, Biotronik, Abbott (Educational Grants); Wolters Kluwer, Oxford University Press (Royalties). BB: none. CY, BS: none. Machelle Wilson-none. JC: none. SMF: Research Grants from NIH, SAMHSA, California Department of Healthcare Services Royalties on books and publications from Wolters Kluwer Publishers, Elsevier Publisher, Oxford University Press.

  • Provenance and peer review Not commissioned; externally peer reviewed.