Dispersal Pattern for Spine Injections (Gadolinium Contrast)
| Status: | Recruiting |
|---|---|
| Conditions: | Neurology, Women's Studies |
| Therapuetic Areas: | Neurology, Reproductive |
| Healthy: | No |
| Age Range: | 18 - 85 |
| Updated: | 4/21/2016 |
| Start Date: | April 2015 |
| End Date: | June 2016 |
| Contact: | Christina L Goldstein, MD |
| Email: | goldsteincl@health.missouri.edu |
| Phone: | 573-882-1440 |
Dispersal Pattern of Injectate After Cervical Epidural Steroid Evaluated With Magnetic Resonance Imaging
This study will analyze injectate dispersal patterns after standard-of-care cervical
epidural steroid injections using gadolinium as a marker and magnetic resonance imaging
(MRI) to characterize the pattern. Although these procedures are performed with high
frequency under the assumption that injectate remains localized to injection site, no
peer-reviewed studies have validated this assumption. Comprehensive characterization of
injectate dispersal patterns will provide important data regarding safety, as well as
diagnostic and therapeutic potential of cervical epidural steroid injections.
epidural steroid injections using gadolinium as a marker and magnetic resonance imaging
(MRI) to characterize the pattern. Although these procedures are performed with high
frequency under the assumption that injectate remains localized to injection site, no
peer-reviewed studies have validated this assumption. Comprehensive characterization of
injectate dispersal patterns will provide important data regarding safety, as well as
diagnostic and therapeutic potential of cervical epidural steroid injections.
Epidural steroid injections have long had an impact in the treatment of various
spine-related conditions, particularly radiculopathy. The efficacy of epidural spinal
injections has been attributed to the anatomic location reached by the injectate. Cervical
epidural steroid injections are also used as an injury location indicator. This application
is based on documenting pain relief after injection into a specific location in the cervical
spine. Both the diagnostic and therapeutic applications for epidurals assume that the
injectate remains local to the injection site in order to have its effects. However, in a
recently completed study, the investigators group documented substantial diffusion of
injectate after lumbar epidurals used computerized tomography (CT) assessments.1 Based on
the exposure to ionizing radiation associated with CT along with the superior imaging
specificity and sensitivity of MRI, the investigators are shifting their imaging modality to
MRI for future studies. The proposed study is designed to evaluate the use of gadolinium and
MRI to assess nature and amount of diffusion of injectate in the cervical region after
standard-of-care epidural injections. To the investigators knowledge, this will be the first
study to critically assess this common procedure in order to evaluate safety and efficacy in
a clinical setting.
spine-related conditions, particularly radiculopathy. The efficacy of epidural spinal
injections has been attributed to the anatomic location reached by the injectate. Cervical
epidural steroid injections are also used as an injury location indicator. This application
is based on documenting pain relief after injection into a specific location in the cervical
spine. Both the diagnostic and therapeutic applications for epidurals assume that the
injectate remains local to the injection site in order to have its effects. However, in a
recently completed study, the investigators group documented substantial diffusion of
injectate after lumbar epidurals used computerized tomography (CT) assessments.1 Based on
the exposure to ionizing radiation associated with CT along with the superior imaging
specificity and sensitivity of MRI, the investigators are shifting their imaging modality to
MRI for future studies. The proposed study is designed to evaluate the use of gadolinium and
MRI to assess nature and amount of diffusion of injectate in the cervical region after
standard-of-care epidural injections. To the investigators knowledge, this will be the first
study to critically assess this common procedure in order to evaluate safety and efficacy in
a clinical setting.
Inclusion Criteria:
- Age 18-85
- Cervical radiculopathy patient as identified by principle investigator
Exclusion Criteria:
- Patients unable to give consent or comply with rehabilitation process
- Pregnant
- Co-morbidities such as infection, malignancy, myelopathy or an uncontrolled medical
condition
- Allergy to injectate
- Anticoagulative state
- Severe claustrophobia
- Non-MRI compatible pacemaker, neurostimulator, bladder stimulator or other mechanical
device
- Renal disease that would cause the patient to be at an increased risk of complication
of receiving the contrast agent
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