Anesth Pain Med.  2018 Oct;13(4):427-434. 10.17085/apm.2018.13.4.427.

Appropriate angle and depth in thoracic transforaminal epidural block in Koreans

• Noh C
• Lee WH
• Ko YK
• Lee SY
• Kim YJ
• Lee SH
• Jung CH
• Kang HM

• KMID: 2436004
• DOI: http://doi.org/10.17085/apm.2018.13.4.427

Abstract

BACKGROUND
Selective transforaminal epidural block has come to the for as a targetspecific modality in the treatment and diagnosis of spinal pain. Thoracic transforaminal epidural block (TTFEB) has the associated risk of pneumothorax. This article describes a retrospective study conducted using computed tomography (CT) imaging to investigate the TTFEB angle and depth appropriate to minimize the risk of pneumothorax in Koreans.
METHODS
The subjects of the present study were 100 randomly selected patients between 50 and 70 years of age found be free of thoracic disease according to chest CT performed in the present hospital. On the chest CT, the superior, middle, and inferior thoracic vertebrae were observed at the T2, T7, and T11 levels, respectively.
RESULTS
The average distance and the needle insertion angle from the skin point at which the needle may be inserted without piercing the lung to the intervertebral foramen were 117.8 ± 12.1 mm and 58.1 ± 6.1° at the T2 level, 85.6 ± 10.0 mm and 61.7 ± 4.3° at the T7 level, and 94.3 ± 8.7 mm and 64.4 ± 7.0° at the T11 level, respectively.
CONCLUSIONS
The needle insertion at the point further than 40 mm, on the upper, middle thorax, if the needle pass from the inner vertebral body to lamina, it could be safer. However, on the lower thorax, needle could pierce the lung though the needle start from the inner vertebral body. Thus, it can be safer if the needle pass toward the exterior margin of lamina.

Keyword

Angle; Depth; Pneumothorax; Thoracic transforaminal epidural block

MeSH Terms

Diagnosis
Humans
Lung
Needles
Pneumothorax
Retrospective Studies
Skin
Thoracic Diseases
Thoracic Vertebrae
Thorax
Tomography, X-Ray Computed

Figure

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  Fig. 1 Computed tomography images and measurement values. Ad: needle insertion distance along the line drawn from the point 40 mm external from the spinous process, grazing the exterior margin of the lamina and arriving at the 1/2 depth of the intervertebral foramen, Alpha: needle insertion angle along the line drawn from the point 40 mm external from the spinous process, grazing the exterior margin of the lamina and arriving at the 1/2 depth of the intervertebral foramen, Cd: needle insertion distance along the line drawn from Point X, grazing the exterior margin of the lamina and arriving at the 1/2 depth of the intervertebral foramen, Theta: needle insertion angle along the line drawn from Point X, grazing the exterior margin of the lamina and arriving at the 1/2 depth of the intervertebral foramen, Xd: distance from Point X to the spinous process, X: needle insertion point where the line form the 1/2 depth of the intervertebral foramen contacts the skin without passing through the lung at the minimum angle.

• 

  Fig. 2 Measurements on computed tomography images at T11 level. Dd: needle insertion distance along the line drawn from Point Y to the 1/2 depth of the intervertebral foramen without passing through the lung, Delta: needle insertion angle along the line drawn from Point Y to the 1/2 depth of the intervertebral foramen without passing through the lung, Yd: distance from Point Y to the spinous process, Y: needle insertion point where the line from the 1/2 depth of the intervertebral foramen contacts the skin without passing through the lung at the largest angle.

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