Technique, Difficulty, And Accuracy Of Computed Tomography-Guided Translaminar And Transforaminal Lumbosacral Epidural And Intraarticular Lumbar Facet Joint Injections In Dogs

Liotta A, Sandersen C, Couvreur T, et al.

Veterinary Radiology & Ultrasound 2016;57:191-198.

In human medicine, spinal pain and radiculopathy are commonly managed by computed tomography (CT)-guided facet joint injections and by transforaminal or translaminar epidural injections. In dogs, CT-guided lumbosacral epidural or lumbar facet joint injections have not been described. The aim of this experimental, ex vivo, feasibility study was to develop techniques and to assess their difficulty and accuracy. Two canine cadavers were used to establish the techniques and eight cadavers to assess difficulty and accuracy. Contrast medium was injected and a CT scan was performed after each injection. Accuracy was assessed according to epidural or joint space contrast opacification. Difficulty was classified as easy, moderately difficult, or difficult, based on the number of CT scans needed to guide insertion of the needle. A total of six translaminar and five transforaminal epidural and 53 joint injections were performed. Translaminar injections had a high success rate (100%), were highly accurate (75%), and easy to perform (100%). Transforaminal injections had an moderately high success rate (75%), were accurate (75%), and moderately difficult to perform (100%). Success rate of facet joint injections was 62% and was higher for larger facet joints, such as L7-S1. Accuracy of facet joint injections ranged from accurate (37–62%) to highly accurate (25%) depending on the volume injected. In 77% of cases, injections were moderately difficult to perform. Possible complications of epidural and facet joint injections were subarachnoid and vertebral venous plexus puncture and periarticular spread, respectively. Further studies are suggested to evaluate in vivo feasibility and safety of these techniques.