Radiation Exposure for Fluoroscopy-guided Lumbosacral Epidural Steroid Injections Comparison of the Transforaminal and Caudal Approaches

Abstract

Study Design:A retrospective investigation.Objective:We evaluated and compared the radiation exposure caused by using the fluoroscopy-guided transforaminal and caudal approaches of lumbosacral epidural steroid injection (ESI).Summary of Background Data:Only a few studies focused on the radiation exposure to patients who underwent lumbosacral ESI for pain management.Materials and Methods:A total of 228 patients (83 males, 145 females; mean age, 63.3 y) who received lumbosacral ESI were included. Transforaminal ESI was performed in 181 patients (67 males, 114 females; mean age, 61.3 y) and caudal ESI was used in 47 patients (16 males, 31 females; mean age, 69.7 y). All ESIs were performed under a single-plane fluoroscopic guidance by 1 musculoskeletal radiologist. The kerma-area product (KAP) and fluoroscopy time were recorded in all patients. Both measurements were correlated and compared for each approach.Results:KAP was 3.02-1048.2 Gy m(2) (mean, 101.7 Gy m(2); median, 67.8 Gy m(2)) for transforaminal ESI and 16.0-604.5 Gy m(2) (mean, 101.8 Gy m(2); median, 54.6 Gy m(2)) for caudal ESI. The fluoroscopy time was 11-161 seconds for transforaminal ESI (mean, 36.0 s; median, 29 s) and 4-78 seconds (mean, 18.2 s; median, 13 s) for caudal ESI. KAP and fluoroscopy time were positively correlated for each approach (P<0.001). Fluoroscopy time was significantly longer for transforaminal ESI (correlation coefficient=-0.77, P=0.000). After correction for the fluoroscopy time, KAP was less in transforaminal ESI than in caudal ESI (correlation coefficient=0.74, P=0.000).Conclusions:The longer the fluoroscopy time, the greater the KAP in both transforaminal and caudal ESIs. The fluoroscopy time for transforaminal ESI was longer than that for caudal ESI. However, KAP of transforaminal ESI was less than that of the caudal ESI, after being corrected for the length of fluoroscopy time.