Figure 1816

CT-discogram, lumbar, anteroposterior view.

tions are used to control the pain. It is believed that it is more effective to deposit the steroids as close as possible to the pathologic processes that are thought to cause the pain.

The use of fluoroscopy allows safe deposition of steroids and anesthetic solutions in the anterior or posterior epidural space of the vertebral canal or in the epidural space of the spinal nerve sleeves.

Common fluoroscopically guided precision therapeutic injections include the following:

• Interlaminar epidural steroid injection

• Caudal epidural steroid injection

• Transforaminal epidural steroid injection

• Selective spinal nerve sleeve steroid injection

• Z joint intra-articular injection

• SI joint intra-articular injection

Fluoroscopy allows performing percutaneous interventions that require precision localization of a needle tip at the level of the targeted structure.

Common fluoroscopically guided interventions include the following:

• Radiofrequency (RF) neurotomy

• Intradiscal electrothermal therapy (IDET)

• Annuloplasty

• Lyses of adhesions

• Percutaneous disc decompression

• Spinal cord stimulation

Interlaminar Epidural Steroid Injection

Deposition of a steroid and local anesthetic solution in the dorsal epidural space via a posterior approach placing the needle between the laminas.

Indications The main indication is deposition of steroids in the dorsal epidural space. It is usually not a technique that can deposit the steroids near the pain-generating structure, but it is the most commonly performed procedure in pain control.

Procedure The needle is introduced into the dorsal epidural space using an interlaminar approach (Figures 18-19 through 1823). and identifying the epidural space utilizing the loss of resistance technique. Some practitioners do not use fluoroscopy for this technique ("blind" technique) even though it has been demonstrated that the blind technique leads to up to 30% mislocalization of the needle.

Caudal Epidural Steroid Injection

Deposition of a steroid and local anesthetic solution in the epi-dural space via a caudal approach placing the needle through the sacral epidural space.

Indications The main indication for caudal epidural steroid injection is for the deposition of steroids in the dorsal epidural space of the sacral and lumbar spine. The injectate usually reaches up to L3 level and not above. It is a useful technique when there is severe ste-

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