Abstract ID: A23

Abstract Title: Fluoroscopically-guided Transforaminal Lumbar Epidural Steroid Injection: A New Needle-inside-Needle Technique.

Poster Type: Either


ABSTRACT BODY

Introduction: Transforaminal lumbar epidural steroid injection is a commonly used technique for diagnosis and treatment of nerve root irritation secondary to herniated disc material (1). The complexity of the conventional oblique approach, the serious complications (2), and high radiation exposure for the patient, radiation technologist and the physician (3), have led to the development of this novel Needle-inside-Needle approach that is simple, safe, swift and accurate method of steroid delivery.

Methods: A 20-gauge (G), 31/2 inch needle guide is introduced at 5’O clock position (7’o clock for left sided lumbar neural foramina) under anterioposterior fluoroscopic image of the desired lumbar pedicle. A previously curved 25G, 6-inch short bevel needle is then introduced through the 20G needle with concavity oriented medially.

Results: An anteroposterior as well as lateral projection is obtained to verify the tranforaminal needle position (Fig 1 a & b). Needle placement is confirmed with injection of Iohexol 300 (iopamide 300 mg/ml), 0.2 - 0.5 ml with medial spread in the epidural space as well laterally along the nerve root (Fig. 2 a & b). The fluoroscopic time required to perform the procedure is 9 ± 5 sec in the hands of anesthesiologists under going interventional pain fellowship.

Conclusion: The oblique transforaminal approach for epidural steroid injection is associated with patient discomfort as well as increase risk of nerve damage. High radiation exposure for both patient and personnel involved during the procedure is also a concern. The Needle-inside-Needle, posterior approach minimizes these problems and may also reduce the risk of nerve damage by use of 25G short bevel spinal needle.

References:
1. Clin Rheumatol (2003) 22:299-304
2. Reg Anesth Pain Med, (2004) 29(3):243-256
3. Arch Phys Med Rehabil (2002) 83: 697- 701



ATTACHED FILES

A23_SNRB-Fig1.bmp

A23_SNRB-Fig2.bmp



Reg Anesth Pain Med 2004; 29(2):A23