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Access routes and reported decision criteria for lumbar epidural drug injections: a systematic literature review

Andreisek, Gustav ; Jenni, Maja ; Klingler, Dominic ; Wertli, Maria ; Elliott, Marina ; Ulbrich, Erika ; Winklhofer, Sebastian ; Steurer, Johann

In: Skeletal Radiology, 2013, vol. 42, no. 12, p. 1683-1692

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    Title
    • Access routes and reported decision criteria for lumbar epidural drug injections: a systematic literature review
    Author
    • Andreisek, Gustav. Department of Radiology, University Hospital Zurich, Ramistrasse 100, CH 8091, Zurich, Switzerland
    • Jenni, Maja. Horten Centre for Patient oriented Research and Knowledge Transfer, University Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
    • Klingler, Dominic. Horten Centre for Patient oriented Research and Knowledge Transfer, University Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
    • Wertli, Maria. Horten Centre for Patient oriented Research and Knowledge Transfer, University Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
    • Elliott, Marina. Department of Archaeology, Simon Fraser University, EDB 9635-8888 University Drive, V5A 1S6, Burnaby, BC, Canada
    • Ulbrich, Erika. Department of Radiology, University Hospital Zurich, Ramistrasse 100, CH 8091, Zurich, Switzerland
    • Winklhofer, Sebastian. Department of Radiology, University Hospital Zurich, Ramistrasse 100, CH 8091, Zurich, Switzerland
    • Steurer, Johann. Horten Centre for Patient oriented Research and Knowledge Transfer, University Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:317700
    Summary
    Purpose: To review lumbar epidural drug injection routes in relation to current practice and the reported criteria used for selecting a given approach. Material and methods: This was a HIPPA-compliant study. Employing a systematic search strategy, the MEDLINE and EMBASE databank as well as the Cochrane Library were searched for studies on epidural drug injections. The following data were noted: access route, level of injection, use of image guidance, and types and doses of injected drugs. Justifications for the use of a particular route were also noted. Data were presented using descriptive statistics. Results: A total of 1,211 scientific studies were identified, of which 91 were finally included (7.5%). The interlaminar access route was used in 44 of 91 studies (48.4%), the transforaminal in 37 of 91 studies (40.7%), and the caudal pathway in 26 of 91 studies (28.6%). The caudal pathway was favored in the older studies whereas the transforaminal route was favored in recent studies. Decision criteria related to correct needle placement, concentration of injected drug at lesion site, technical complexity, costs, and potential complications. Injection was usually performed on the level of the lesion using local anesthetics (71 of 91 studies, 78.0%), steroids (all studies) and image guidance (71 of 91 studies, 78%). Conclusions: The most commonly used access routes for epidural drug injection are the interlaminar and transforaminal pathways at the level of the pathology. Transforaminal routes are being performed with increasing frequency in recent years