Prevalence of Anatomic Impediments to Interlaminar Lumbar Epidural Steroid Injection
Abstract Hameed F, Hunter DJ, Rainville J, Li L, Suri P. Prevalence of anatomic impediments to interlaminar lumbar epidural steroid injection. Objective To determine the prevalence of anatomic impediments to interlaminar lumbar epidural steroid injection (LESI) in a community-based population. Desig...
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| description | Abstract Hameed F, Hunter DJ, Rainville J, Li L, Suri P. Prevalence of anatomic impediments to interlaminar lumbar epidural steroid injection. Objective To determine the prevalence of anatomic impediments to interlaminar lumbar epidural steroid injection (LESI) in a community-based population. Design Cross-sectional observational study. Setting Community-based. Participants Older adults (N=333) sampled irrespective of back pain status. Interventions Not applicable. Main Outcome Measures Computed tomography evaluation of 5 potential anatomic impediments to interlaminar LESI at the L2-S1 spinal levels, including (1) ligamentum flavum (LF) calcification, (2) interspinous ligament (ISL) calcification, (3) spinous process (SP) contact, (4) the absence of epidural fat in the posterior epidural space, and (5) the presence of fat density superficial to the LF in the midsagittal plane. Independent variables included age, sex, body mass index (BMI), and current smoking. Results LF and ISL calcifications were prevalent in 3% to 7% and 2% to 3% of spinal levels, respectively, without significant differences by spinal level. SP contact was most common at the L4-5 level (22%). Absence of posterior epidural fat was very common at L5-S1 (65%), but infrequent at other levels. The presence of midline fat density superficial to LF was most common at L5-S1 (55%). The prevalence of LF calcification, ISL calcification, and SP contact increased with age, but the prevalence of absence of posterior epidural fat and the presence of a midline fat density superficial to LF did not. Sex and smoking status were not associated with the prevalence of anatomic impediments, but higher BMI was associated with a lower prevalence of absence of posterior epidural fat. Conclusions Anatomic impediments to interlaminar LESI were common in this community-based population, particularly at the L5-S1 spinal level. Because of the high overall prevalence of anatomic impediments, and differences in prevalence by spinal level, knowledge of the distribution and frequency of these impediments may aid in aspects of decision-making for the interventional spine physician. |
| doi_str_mv | 10.1016/j.apmr.2011.08.024 |
| format | Article |
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Prevalence of anatomic impediments to interlaminar lumbar epidural steroid injection. Objective To determine the prevalence of anatomic impediments to interlaminar lumbar epidural steroid injection (LESI) in a community-based population. Design Cross-sectional observational study. Setting Community-based. Participants Older adults (N=333) sampled irrespective of back pain status. Interventions Not applicable. Main Outcome Measures Computed tomography evaluation of 5 potential anatomic impediments to interlaminar LESI at the L2-S1 spinal levels, including (1) ligamentum flavum (LF) calcification, (2) interspinous ligament (ISL) calcification, (3) spinous process (SP) contact, (4) the absence of epidural fat in the posterior epidural space, and (5) the presence of fat density superficial to the LF in the midsagittal plane. Independent variables included age, sex, body mass index (BMI), and current smoking. Results LF and ISL calcifications were prevalent in 3% to 7% and 2% to 3% of spinal levels, respectively, without significant differences by spinal level. SP contact was most common at the L4-5 level (22%). Absence of posterior epidural fat was very common at L5-S1 (65%), but infrequent at other levels. The presence of midline fat density superficial to LF was most common at L5-S1 (55%). The prevalence of LF calcification, ISL calcification, and SP contact increased with age, but the prevalence of absence of posterior epidural fat and the presence of a midline fat density superficial to LF did not. Sex and smoking status were not associated with the prevalence of anatomic impediments, but higher BMI was associated with a lower prevalence of absence of posterior epidural fat. Conclusions Anatomic impediments to interlaminar LESI were common in this community-based population, particularly at the L5-S1 spinal level. Because of the high overall prevalence of anatomic impediments, and differences in prevalence by spinal level, knowledge of the distribution and frequency of these impediments may aid in aspects of decision-making for the interventional spine physician.</description><identifier>ISSN: 0003-9993</identifier><identifier>EISSN: 1532-821X</identifier><identifier>DOI: 10.1016/j.apmr.2011.08.024</identifier><identifier>PMID: 22289247</identifier><identifier>CODEN: APMHAI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adipose Tissue - diagnostic imaging ; Age Factors ; Aged ; Biological and medical sciences ; Body Mass Index ; Calcinosis - diagnostic imaging ; Cross-Sectional Studies ; Diseases of the osteoarticular system ; Diseases of the spine ; Female ; Glucocorticoids - therapeutic use ; Humans ; Injections, Epidural ; Ligamentum Flavum - diagnostic imaging ; Low back pain ; Lumbar Vertebrae - diagnostic imaging ; Male ; Medical sciences ; Middle Aged ; Miscellaneous ; Pathological conditions, anatomical ; Physical Medicine and Rehabilitation ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Rehabilitation ; Spine ; Tomography, X-Ray Computed</subject><ispartof>Archives of physical medicine and rehabilitation, 2012-02, Vol.93 (2), p.339-343</ispartof><rights>American Congress of Rehabilitation Medicine</rights><rights>2012 American Congress of Rehabilitation Medicine</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.</rights><rights>2012 by the American Congress of Rehabilitation Medicine 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c539t-c44862c0835d01bfc82df496934c7fdfb05f5cd6221ac4c3db1eba0b68ab75893</citedby><cites>FETCH-LOGICAL-c539t-c44862c0835d01bfc82df496934c7fdfb05f5cd6221ac4c3db1eba0b68ab75893</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.apmr.2011.08.024$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3549,27923,27924,45994</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25967827$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22289247$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hameed, Farah, MD</creatorcontrib><creatorcontrib>Hunter, David J., MBBS, PhD</creatorcontrib><creatorcontrib>Rainville, James, MD</creatorcontrib><creatorcontrib>Li, Ling, MPH</creatorcontrib><creatorcontrib>Suri, Pradeep, MD, MS</creatorcontrib><title>Prevalence of Anatomic Impediments to Interlaminar Lumbar Epidural Steroid Injection</title><title>Archives of physical medicine and rehabilitation</title><addtitle>Arch Phys Med Rehabil</addtitle><description>Abstract Hameed F, Hunter DJ, Rainville J, Li L, Suri P. Prevalence of anatomic impediments to interlaminar lumbar epidural steroid injection. Objective To determine the prevalence of anatomic impediments to interlaminar lumbar epidural steroid injection (LESI) in a community-based population. Design Cross-sectional observational study. Setting Community-based. Participants Older adults (N=333) sampled irrespective of back pain status. Interventions Not applicable. Main Outcome Measures Computed tomography evaluation of 5 potential anatomic impediments to interlaminar LESI at the L2-S1 spinal levels, including (1) ligamentum flavum (LF) calcification, (2) interspinous ligament (ISL) calcification, (3) spinous process (SP) contact, (4) the absence of epidural fat in the posterior epidural space, and (5) the presence of fat density superficial to the LF in the midsagittal plane. Independent variables included age, sex, body mass index (BMI), and current smoking. Results LF and ISL calcifications were prevalent in 3% to 7% and 2% to 3% of spinal levels, respectively, without significant differences by spinal level. SP contact was most common at the L4-5 level (22%). Absence of posterior epidural fat was very common at L5-S1 (65%), but infrequent at other levels. The presence of midline fat density superficial to LF was most common at L5-S1 (55%). The prevalence of LF calcification, ISL calcification, and SP contact increased with age, but the prevalence of absence of posterior epidural fat and the presence of a midline fat density superficial to LF did not. Sex and smoking status were not associated with the prevalence of anatomic impediments, but higher BMI was associated with a lower prevalence of absence of posterior epidural fat. Conclusions Anatomic impediments to interlaminar LESI were common in this community-based population, particularly at the L5-S1 spinal level. Because of the high overall prevalence of anatomic impediments, and differences in prevalence by spinal level, knowledge of the distribution and frequency of these impediments may aid in aspects of decision-making for the interventional spine physician.</description><subject>Adipose Tissue - diagnostic imaging</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Body Mass Index</subject><subject>Calcinosis - diagnostic imaging</subject><subject>Cross-Sectional Studies</subject><subject>Diseases of the osteoarticular system</subject><subject>Diseases of the spine</subject><subject>Female</subject><subject>Glucocorticoids - therapeutic use</subject><subject>Humans</subject><subject>Injections, Epidural</subject><subject>Ligamentum Flavum - diagnostic imaging</subject><subject>Low back pain</subject><subject>Lumbar Vertebrae - diagnostic imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Pathological conditions, anatomical</subject><subject>Physical Medicine and Rehabilitation</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Rehabilitation</subject><subject>Spine</subject><subject>Tomography, X-Ray Computed</subject><issn>0003-9993</issn><issn>1532-821X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kt-L1DAQx4Mo3nr6D_ggfZF7ak0mTZuAHBzHqQsLCneCbyFNUs3aJjVpF-6_N2XX88eDT8Mwn5n5Mt9B6CXBFcGkebOv1DTGCjAhFeYVhvoR2hBGoeRAvjxGG4wxLYUQ9Aw9S2mf04ZR8hSdAQAXULcbdPcp2oMarNe2CH1x5dUcRqeL7ThZ40br51TModj62cZBjc6rWOyWscvhZnJmiWoobnMtOJOhvdWzC_45etKrIdkXp3iOPr-7ubv-UO4-vt9eX-1KzaiYS13XvAGNOWUGk67XHExfi0bQWre96TvMeqZNA0CUrjU1HbGdwl3DVdcyLug5ujzOnZZutEZntVmPnKIbVbyXQTn5d8W7b_JrOEjKmlYAzwMuTgNi-LHYNMvRJW2HQXkbliQFEQCMNZBJOJI6hpSi7R-2ECxXN-Rerm7I1Q2Jucxu5KZXf-p7aPl1_gy8PgEqaTX0UXnt0m-OiablsHJvj5zN1zw4G2XSbvXMuJhPLk1w_9dx-U-7Hpx3eeN3e2_TPizRZ58kkQkklrfr36xvQwjGLcMt_QmHLb-O</recordid><startdate>20120201</startdate><enddate>20120201</enddate><creator>Hameed, Farah, MD</creator><creator>Hunter, David J., MBBS, PhD</creator><creator>Rainville, James, MD</creator><creator>Li, Ling, MPH</creator><creator>Suri, Pradeep, MD, MS</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20120201</creationdate><title>Prevalence of Anatomic Impediments to Interlaminar Lumbar Epidural Steroid Injection</title><author>Hameed, Farah, MD ; Hunter, David J., MBBS, PhD ; Rainville, James, MD ; Li, Ling, MPH ; Suri, Pradeep, MD, MS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c539t-c44862c0835d01bfc82df496934c7fdfb05f5cd6221ac4c3db1eba0b68ab75893</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adipose Tissue - diagnostic imaging</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Body Mass Index</topic><topic>Calcinosis - diagnostic imaging</topic><topic>Cross-Sectional Studies</topic><topic>Diseases of the osteoarticular system</topic><topic>Diseases of the spine</topic><topic>Female</topic><topic>Glucocorticoids - therapeutic use</topic><topic>Humans</topic><topic>Injections, Epidural</topic><topic>Ligamentum Flavum - diagnostic imaging</topic><topic>Low back pain</topic><topic>Lumbar Vertebrae - diagnostic imaging</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Miscellaneous</topic><topic>Pathological conditions, anatomical</topic><topic>Physical Medicine and Rehabilitation</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. 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Prevalence of anatomic impediments to interlaminar lumbar epidural steroid injection. Objective To determine the prevalence of anatomic impediments to interlaminar lumbar epidural steroid injection (LESI) in a community-based population. Design Cross-sectional observational study. Setting Community-based. Participants Older adults (N=333) sampled irrespective of back pain status. Interventions Not applicable. Main Outcome Measures Computed tomography evaluation of 5 potential anatomic impediments to interlaminar LESI at the L2-S1 spinal levels, including (1) ligamentum flavum (LF) calcification, (2) interspinous ligament (ISL) calcification, (3) spinous process (SP) contact, (4) the absence of epidural fat in the posterior epidural space, and (5) the presence of fat density superficial to the LF in the midsagittal plane. Independent variables included age, sex, body mass index (BMI), and current smoking. Results LF and ISL calcifications were prevalent in 3% to 7% and 2% to 3% of spinal levels, respectively, without significant differences by spinal level. SP contact was most common at the L4-5 level (22%). Absence of posterior epidural fat was very common at L5-S1 (65%), but infrequent at other levels. The presence of midline fat density superficial to LF was most common at L5-S1 (55%). The prevalence of LF calcification, ISL calcification, and SP contact increased with age, but the prevalence of absence of posterior epidural fat and the presence of a midline fat density superficial to LF did not. Sex and smoking status were not associated with the prevalence of anatomic impediments, but higher BMI was associated with a lower prevalence of absence of posterior epidural fat. Conclusions Anatomic impediments to interlaminar LESI were common in this community-based population, particularly at the L5-S1 spinal level. Because of the high overall prevalence of anatomic impediments, and differences in prevalence by spinal level, knowledge of the distribution and frequency of these impediments may aid in aspects of decision-making for the interventional spine physician.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>22289247</pmid><doi>10.1016/j.apmr.2011.08.024</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adipose Tissue - diagnostic imaging Age Factors Aged Biological and medical sciences Body Mass Index Calcinosis - diagnostic imaging Cross-Sectional Studies Diseases of the osteoarticular system Diseases of the spine Female Glucocorticoids - therapeutic use Humans Injections, Epidural Ligamentum Flavum - diagnostic imaging Low back pain Lumbar Vertebrae - diagnostic imaging Male Medical sciences Middle Aged Miscellaneous Pathological conditions, anatomical Physical Medicine and Rehabilitation Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Rehabilitation Spine Tomography, X-Ray Computed |
| title | Prevalence of Anatomic Impediments to Interlaminar Lumbar Epidural Steroid Injection |
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