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pISSN 2005-9159
eISSN 2093-0569
eISSN 2093-0569
Korean J Pain 2023; 36(1): 98-105
Published online January 1, 2023 https://doi.org/10.3344/kjp.22227
Copyright © The Korean Pain Society.
Ye Sull Kim1,2,3 
, SeongOk Park1 , Chanhong Lee1 , Sang-Kyi Lee1,2,3 , A Ram Doo1,2,3 , Ji-Seon Son1,2,3
1Department of Anesthesiology and Pain Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
2Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
3Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
Correspondence to:Ji-Seon Son
Department of Anesthesiology and Pain Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea
Tel: +82-63-250-1241, Fax: +82-63-250-1240, E-mail: sjs6803@jbnu.ac.kr
Handling Editor: Yeon-Dong Kim
Received: July 4, 2022; Revised: September 15, 2022; Accepted: September 25, 2022
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Ultrasound-guided first sacral transforaminal epidural steroid injection (S1 TFESI) is a useful and easily applicable alternative to fluoroscopy or computed tomography (CT) in lumbosacral radiculopathy. When a needle approach is used, poor visualization of the needle tip reduces the accuracy of the procedure, increasing its difficulty. This study aimed to improve ultrasound-guided S1 TFESI by evaluating radiological S1 posterior foramen data obtained using three-dimensional CT (3D-CT).
Methods: Axial 3D-CT images of the pelvis were retrospectively analyzed. The radiological measurements obtained from the images included 1st posterior sacral foramen depth (S1D, mm), 1st posterior sacral foramen width (S1W, mm), the angle of the 1st posterior sacral foramen (S1A, °), and 1st posterior sacral foramen distance (S1ds, mm). The relationship between the demographic factors and measured values were then analyzed.
Results: A total of 632 patients (287 male and 345 female) were examined. The mean S1D values for males and females were 11.9 ± 1.9 mm and 10.6 ± 1.8 mm, respectively (P < 0.001); the mean S1A 28.2 ± 4.8° and 30.1 ± 4.9°, respectively (P < 0.001); and the mean S1ds, 24.1 ± 2.9 mm and 22.9 ± 2.6 mm, respectively (P < 0.001); however, the mean S1W values were not significantly different. Height was the only significant predictor of S1D (β = 0.318, P = 0.004).
Conclusions: Ultrasound-guided S1 TFESI performance and safety may be improved with adjustment of needle insertion depth congruent with the patient’s height.
Keywords: Epidural Space, Fluoroscopy, Injections, Epidural, Low Back Pain, Pain Management, Radiculopathy, Sacrum, Steroids, Tomography, X-ray Computed, Ultrasonography, Interventional.
