Atlas of Image-Guided Spinal Procedures E-Book

Michael Bruce Furman, Leland Berkwits, Isaac Cohen, Brad Goodman, Jonathan Kirschner, Thomas S. Lee, Paul Sean Lin

• Publisher: Elsevier
• Year: 2017
• ISBN:
  9780323497343
• Edition: 2
• Topic: Medicine
• Subtopic: Anesthesiology & Pain Management

Give your patients the non-surgical spine pain relief they need with help from the Atlas of Image-Guided Spinal Procedures by Dr. Michael Bruce Furman. This medical reference book features a highly visual atlas format that shows you exactly how to safely and efficiently perform each technique step-by-step.

A unique, systematic, safe, and efficient approach makes Atlas of Image-Guided Spinal Procedures your go-to resource for spine pain relief for your patients. The highly visual format shows you exactly how to perform each technique, highlighting imaging pearls and emphasizing optimal and suboptimal imaging. Updated content includes ultrasound techniques and procedures for "spine mimickers, " including hip and shoulder image-guided procedures, keeping you on the cutting edge of contemporary spine pain-relief methods.

• Safely and efficiently relieve your patients' pain with consistent, easy-to-follow chapters that guide you through each technique.
• Highly visual atlas presentation of an algorithmic, image-guided approach for each technique: trajectory view (demonstrates fluoroscopic "set up"); multi-planar confirmation views (AP, lateral, oblique); and safety view (what should be avoided during injection), along with optimal and suboptimal contrast patterns.
• Special chapters on Needle Techniques, Procedural Safety, Fluoroscopic and Ultrasound Imaging Pearls, Radiation Safety, and L5-S1 Disc Access provide additional visual instruction.
• View drawings of radiopaque landmarks and key radiolucent anatomy that cannot be viewed fluoroscopically.

• Includes new and unique diagrams demonstrating cervical, thoracic, and lumbar radiofrequency probe placement and treatment zones on multi-planar views.
• Features new coverage of ultrasound techniques, as well as image-guided procedures for "spine mimickers, " such as hip and shoulder.

Section III

Lumbar/Lumbosacral

Outline

Chapter 12. Lumbar Interlaminar Epidural Steroid Injection: Paramedian Approach

Chapter 13. Lumbar Transforaminal Epidural Steroid Injection

Chapter 13A. Lumbar Transforaminal Epidural Steroid Injection—Supraneural (Traditional) Approach: Fluoroscopic Guidance

Chapter 13B. Lumbar Transforaminal Epidural Steroid Injection—Supraneural, Two-Needle Technique: Fluoroscopic Guidance

Chapter 13C. Lumbar Transforaminal Epidural Steroid Injection—Infraneural Approach: Fluoroscopic Guidance

Chapter 13D. Lumbar Transforaminal Epidural Steroid Injection: Needle Localization Diagram

Chapter 14. Lumbar Myelography

Chapter 15. Lumbar Zygapophysial (Facet) Joint Procedures

Chapter 15A. Lumbar Zygapophysial Intraarticular Joint Injection—Posterior Approach: Fluoroscopic Guidance

Chapter 15B. Lumbar Zygapophysial Joint Nerve (Medial Branch) Injection—Oblique Approach: Fluoroscopic Guidance

Chapter 15C. Lumbar Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy—Posterior Approach: Fluoroscopic Guidance

Chapter 15D. Lumbar Medial Branch Blocks—Midline: Ultrasound Guidance

Chapter 15E. Lumbar Zygapophysial Joint Innervation, Anatomy, Dissections, and Lesion Zone Diagrams

Chapter 16. Lumbar Sympathetic Block

Chapter 17. Lumbar Provocation Discography/Disc Access

Chapter 17A. Lumbar Provocation Discography/Disc Access: Standard Fluoroscopic Techniques

Chapter 17B. L5-S1 Disc Access

Chapter 12: Lumbar Interlaminar Epidural Steroid Injection

Paramedian Approach

S. Amir Tahaei, Scott J. Davidoff, and Michael B. Furman

Abstract

Lumbar interlaminar epidural injections are commonly performed for a variety of spinal pain disorders. They are specifically indicated for radicular symptoms with or without axial pain experienced because of a lumbosacral etiology. Because the injectate disperses over a larger area with interlaminar epidural injection than with transforaminal injection, this type of injection is typically used for bilateral or multilevel symptoms.

Keywords

contralateral oblique; disc herniation; epidural injection; interlaminar; lumbar; radiculopathy; spinal stenosis; spinolaminar line; ventral interlaminar line

Note: Please see pages ii and iii for a list of anatomic terms/abbreviations used throughout this book.

Lumbar interlaminar epidural injections are commonly performed for a variety of spinal pain disorders. They are specifically indicated for radicular symptoms with or without axial pain experienced because of a lumbosacral etiology. Because the injectate disperses over a larger area with interlaminar epidural injection than with transforaminal injection, this type of injection is typically used for bilateral or multilevel symptoms.

With the approach described here, the needle is placed with the use of a trajectory view and advanced with the use of multiplanar imaging, with emphasis on safely using the contralateral oblique (CLO) and/or lateral view to confirm the depth by visualizing the ventral interlaminar line (VILL) or spinolaminar line, respectively.

The CLO view is preferable to the lateral view in advancing the needle to gain access to the interlaminar space. The role of the CLO view is especially preferable to the lateral view, as discussed in ...