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

Kim, Seon-Jeong MD*,†; Lee, Min Hee MD, PhD*; Lee, Sheen-Woo MD, PhD; Chung, Hye Won MD, PhD*; Lee, Sang Hoon MD, PhD*; Shin, Myung Jin MD, PhD*

Journal of Spinal Disorders and Techniques: February 2014 - Volume 27 - Issue 1 - p E37–E40
doi: 10.1097/BSD.0b013e31829eb80f

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 μGy m2 (mean, 101.7 μGy m2; median, 67.8 μGy m2) for transforaminal ESI and 16.0–604.5 μGy m2 (mean, 101.8 μGy m2; median, 54.6 μGy m2) 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.

*Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul

Department of Radiology, Inje University Haeundae Paik Hospital, Busan

Department of Radiology, Gachon University Gil Hospital, Incheon, South Korea

The authors declare no conflict of interest.

Reprints: Min Hee Lee, MD, PhD, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea (e-mail:

Received February 28, 2013

Accepted May 23, 2013

© 2014 by Lippincott Williams & Wilkins, Inc.