ACCURACY OF TRANSFORAMINAL LUMBAR 5 EPIDURAL INJECTION BY ULTRASOUND GUIDANCE CONFIRMED BY FLUOROSCOPE AND DYE INJECTION

Background: Transforaminal epidural injection of lumbar vertebrae 5 is the agreeable procedure for the treatment of lumbar radicular pain. The process is under Fluoroscopic guidance to ensure delicate needle positioning and to exclude intravascular injection but the negative point was exposure to radiation and the need to wear heavy lead apron. Ultrasound technique is considered to be low risk intervention and help to identify soft tissue target without radiation so the US guidance is thought to be an attractive alternative to fluoroscopy. Aim: The aim of study was to determine the accuracy of needle tip under ultrasound guidance thereafter confirmed with fluoroscopy in patient who is subjected to transforaminal nerve root injection. Patient and Method: A total of 20 patients with lumbar vertebrae 5 disc prolapse and radiculopathy referring to department of pain whose diagnosis were previously confirmed by Magnetic resonance imaging and were selected to undergo lumbar transforaminal epidural injection. The ultrasound guidance was used to perform transforaminal epidural injection. A needle was placed under the guidance of ultrasound and then confirmed with fluoroscope for dye spread. Results: The successful rate of ultrasound guided interventions was 95%(19) of 20 patient as confirmed by fluoroscopy and there was only one failed case in the ultrasound guided. There was significant association between ultrasound approach success and the fluoroscopy and there was significant positive correlation between ultrasound approach trials and number of fluoroscopy images. Ultrasound trials were significantly higher in failed ultrasound approach and in patients weighed 60-79kg. The number of images required in ultrasound approach was significantly lower than the number of images required in fluoroscopy approach. Conclusion: Ultrasound guided lumber transforaminal epidural injections are accurate and practical in clinical cases with successful rate of 95%, ultrasound guidance has decreased radiation exposure and decreased need of operative room to significant level in this study.