Comparison of Radiation Doses of Contralateral Oblique and Lateral View for Fluoroscopy-Guided Lumbar Interlaminar Epidural Steroid Injection.

ABSTRACT

BACKGROUND: Despite newly developing technologies and techniques, the use of fluoroscopic guidance in spinal interventional treatments remains popular. Therefore, it is essential to set reference standards and techniques for reducing radiation exposure in fluoroscopy-guided procedures. OBJECTIVE: The aim of this study was is to compare the radiation doses and procedure time of the contralateral oblique (CLO) view to  lateral view imaging during fluoroscopy-guided spinal procedures. STUDY DESIGN: A retrospective study. SETTING: Pain management unit of a tertiary care center. METHODS: An evaluation of patients who received epidural steroid injections between May 2021 and May 2023 in a university hospital interventional pain management center was performed. This observational study was conducted with 248 patients aged 18 and older who underwent lumbar interlaminar epidural injections (ILESI) confirmed by CLO or lateral oblique imaging. The primary outcomes were the comparison of radiation dose and procedure time between the 2 groups. The secondary outcome was the comparison of complication rates. RESULTS: There were no significant differences between the two groups in terms of age, gender, diagnosis, body mass index, procedure level, Numeric Rating Scale, and procedure time. Although the radiation dose was lower in the CLO group, there was no significant difference between the 2 groups. However, there was a significant difference between the 2 groups in terms of complications (P < 0.001). LIMITATIONS: The study was designed in a single center and performing all the procedures with the same fluoroscopy device makes it difficult to generalize our results. CONCLUSIONS: Although there was no difference in terms of radiation dose and duration of procedure between lumbar ILESI conducting using the CLO or lateral view fluoroscopy imaging, there was a significant difference in terms of complications. Therefore, conducting lumbar ILESI using a CLO view minimizes the complication rate.