Korean J Pain.  2021 Jun;34(3):339-345. 10.3344/kjp.2021.34.3.339.

Prediction of successful caudal epidural injection using color Doppler ultrasonography in the paramedian sagittal oblique view of the lumbosacral spine

  • 1Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
  • 2Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
  • 3Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea


Ultrasound-guided caudal epidural injection (CEI) is limited in that it cannot confirm drug distribution at the target site without fluoroscopy. We hypothesized that visualization of solution flow through the inter-laminar space of the lumbosacral spine using color Doppler ultrasound alone would allow for confirmation of drug distribution. Therefore, we aimed to prospectively evaluate the usefulness of this method by comparing the color Doppler image in the paramedian sagittal oblique view of the lumbosacral spine (LS-PSOV) with the distribution of the contrast medium observed during fluoroscopy.
Sixty-five patients received a 10-mL CEI of solution containing contrast medium under ultrasound guidance. During injection, flow was observed in the LSPSOV using color Doppler ultrasonography, following which it was confirmed using fluoroscopy. The presence of contrast image at L5-S1 on fluoroscopy was defined as “successful CEI.” We then calculated prediction accuracy for successful CEI using color Doppler ultrasonography in the LS-PSOV. We also investigated the correlation between the distribution levels measured via color Doppler and fluoroscopy.
Prediction accuracy with color Doppler ultrasonography was 96.9%. The sensitivity, specificity, positive predictive value, and negative predictive value were 96.7%, 100%, 100%, and 60.0%, respectively. In 52 of 65 patients (80%), the highest level at which contrast image was observed was the same for both color Doppler ultrasonography and fluoroscopy.
Our findings demonstrate that color Doppler ultrasonography in the LS-PSOV is a new method for determining whether a drug solution reaches the lumbosacral region (i.e., the main target level) without the need for fluoroscopy.


Anesthesia; Caudal; Contrast Media; Equivalence Trial; Fluoroscopy; Injections; Epidural; Low Back Pain; Lumbar Vertebrae; Sensitivity and Specificity; Ultrasonography; Doppler; Color; Ultrasonography; Interventional
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