SPINE INJECTION-PROCEDURAL RISK

SUMMARY

1. Sedation: risk of aspiration & respiratory depression; the patient should have no clear liquids for 2 hrs and no solids for 6 hrs before the procedure.

2. Contrast agents: using the lowest possible dose of the nonionic form of contrast helps to minimize the risk of developing renal toxicity; keeping the iodine dose < 3g minimizes toxicity;

3. Gadolinium: can substitute iodinated contrast and has less toxicity.

4. Metformin: Metformin can increase the risk of renal toxicity and precipitate severe lactic acidosis in diabetic patients, withhold it after the use of iodinated contrast.

5. Nephrotoxic meds: combining contrast with nephrotoxic meds increases risk of renal toxicity.

Reference(s)

Furman, Michael B., and Leland Berkwits. Atlas of Image-Guided Spinal Procedures. Elsevier, Inc, 2017.
Horowitz AL. MRI Physics for Physicians. Springer Science & Business Media. (1989) ISBN:1468403338.
Mangrum W, Christianson K, Duncan S et-al. Duke Review of MRI Principles. Mosby. (2012) ISBN:1455700843.