Transcript Flouro Images of Lumbar Spine Injections

Flouro Images of Lumbar Spine
Injections
David F. Drake, MD
Director, VCU PM&R Pain
Fellowship
David Berkower, MD
2003-4 Pain Fellow
Using Contrast Dye
• The following views were obtained using an
injection dummy and therefore no contrast
dye was used.
• We recommend, when available, the use of
contract dye to confirm needle placement
Lumbar Median Branch Block
(MBB)
The flouro is placed
in the oblique position
at approx 30 degrees
to view the “scotty dog”.
The needle is directed at
the eye of the “scotty
dog” and advanced until
bone is contacted.
Needle
Lumbar Facet Injection
A lumbar facet injection
would be done in a similar
fashion as a MBB, however
the target is the facet joint
(between the ear of the lower
“scotty dog” and the front
foot of the upper “scotty
dog”).
Sacroiliac Injection
The flouro is placed
just off AP in order to
align the inferior poles
of the SIJ. The needle
is advanced into the
inferior poles until a
loss of resistance is
appreciated.
Needle
AP View of Lateral Hip Injection
The lateral hip approach
avoids the nerves and
vessels which may be
encountered in the anterior
approach. It’s wise to get a
lateral flouro view to
confirm needle placement.
AP View of Anterior Hip
Injection
When performing a hip
injection from the anterior,
the artery should be palpated
at all times and gentle
negative pressure (aspiration)
in the syringe is important to
avoid intravascular injection.
AP View of Anterior Hip
Injection – Part 2
A different view
Oblique View of Lumbar
Transforaminal Epidural
Place the flouro in the
oblique position (approx 30
deg). Focus the needle
under the chin of the “scotty
dog” [superior aspect of
lateral foramen].
Needle
Lateral View of Lumbar
Transforaminal
Obtain a lateral view to
confirm needle is w/in
the foramen.
AP View of Lumbar
Transforaminal
Finally, obtain an AP view
To confirm the needle is
Medial enough and w/in the
Epidural space.
*Note: for a selective spinal
nerve injection the needle
should be more lateral and
not w/in the epidural space.
Oblique View of Disc Injection
The flouro is placed in the
oblique position [approx
30 deg]. The needle is
advanced into the disc
space. A firm, fibrous
sensation is often felt when
entering the disc.
Lateral View of Disc Injection
A lateral flouro view is
obtained to confirm
needle depth.
AP View of Disc Injection
An AP view may be
obtained to assess how
medial the needle is.
Oblique Lumbar Sympathetic
Block
An oblique flouro view
[approx 30 deg] is obtained.
The needle is directed just
anterior to the L-3 vertebral
body.
Needle