Unintentional vascular uptake in fluoroscopically guided, contrast-confirmed spinal injections - A 1-yr clinical experience and discussion of findings

Objective: Documentation of vascular uptake on spinal injection in the context of negative aspiration and negative passive filling of blood into the hub of the needle. Design: A total of 1,295 consecutive outpatients receiving fluoroscopically guided, contrast-confirmed injection in a multispecialty practice over a 1-yr time frame were retrospectively reviewed with passive observation for inadvertent vascular uptake, passive filling, and required repositioning. Results: Positive vascular uptake was seen in 2-13% of cases with variable degrees of aspiration, passive filling, and required needle repositionings to avoid vascular uptake. Conclusion: Negative aspiration and allotment for passive filling is inadequate to confirm the absence of vascular injection. Spinal injection will never be risk free. The safest method is fluoroscopically guided, contrast-confirmed injection, which should be considered the current standard of care.