Korean J Pain.  2011 Dec;24(4):216-220. 10.3344/kjp.2011.24.4.216.

Analysis of Influencing Factors to Depth of Epidural Space for Lumbar Transforaminal Epidural Block in Korean

• Kim LK
• Kim JR
• Shin SS
• Kim IJ
• Kim BN
• Hwang GT

• KMID: 2074016
• DOI: http://doi.org/10.3344/kjp.2011.24.4.216

Abstract

BACKGROUND
Transforaminal epidural steroid injection is one of the effective treatments in managing radicular pain. There have been some prospective studies on the depth to the epidural space with the transforaminal approach. However, there have been no studies about the depth in Asians, especially Koreans. This study was carried out in order to evaluate the depth to the epidural space and the oblique angle and factors that influence the depth to the epidural space during lumbar transforaminal epidural injection.
METHODS
A total of 248 patients undergoing fluoroscopically guided transforaminal epidural steroid injections were evaluated. At the L3-4, L4-5, L5-S1, and S1 levels, we measured the oblique angle and depth to the epidural space.
RESULTS
Needle depth was positively associated with body mass index (correlation coefficient 0.52, P = 0.004). The median depths (in centimeters) to the epidural space were 6.13 cm, 6.42 cm, and 7.13 cm for 50-60 kg, 60-70 kg, and 70-80 kg groups, respectively, at L5-S1. Age and height were not significantly associated with the needle depth.
CONCLUSIONS
There is a positive association between the BMI (and weight) and transforaminal epidural depth but not with age, sex, and height.

Keyword

BMI; correlation; depth; transforaminal epidural injection

MeSH Terms

Asian Continental Ancestry Group
Body Mass Index
Epidural Space
Humans
Needles

Reference

1. Hong JH, Lee YC, Lee HM, Kang CH. An analysis of the outcome of transforaminal epidural steroid injections in Patients with spinal stenosis or herniated Intervertebral Discs. Korean J Pain. 2008; 21:38–43.

2. Goodman BS, Posecion LW, Mallempati S, Bayazitoglu M. Complications and pitfalls of lumbar interlaminar and transforaminal epidural injections. Curr Rev Musculoskelet Med. 2008; 1:212–222. PMID: 19468908.

3. Kim DW, Shim JC, Shin YC. Evaluation of contrast flow patterns with fluoroscopic guided lumbar transforaminal epidural injections. J Korean Pain Soc. 2004; 17:159–165.

4. Choi BI, Han JM, Kweon TD, Lee YW. The prognostic factors of selective transforaminal epidural block in patients with low back pain. Korean J Pain. 2007; 20:54–59.

5. Brummett CM, Williams BS, Hurley RW, Erdek MA. A prospective, observational study of the relationship between body mass index and depth of the epidural space during lumbar transforaminal epidural steroid injection. Reg Anesth Pain Med. 2009; 34:100–105. PMID: 19282707.

6. D'Alonzo RC, White WD, Schultz JR, Jaklitsch PM, Habib AS. Ethnicity and the distance to the epidural space in parturients. Reg Anesth Pain Med. 2008; 33:24–29. PMID: 18155053.