Figure 1823

Interlaminal epidural injection, cervical, anteroposterior view of epidurogram.

nosis of the lumbar spine with abundant spondylotic changes that prevent safe interlaminar or transforaminal injection of steroids. The use of fluoroscopy is helpful in this injection to document proper spread of the injectate and to exclude intravascular injection that will negate the localized effects of the steroids.

Procedure Aseptic skin preparation requires meticulous technique and extra passes with the aseptic solutions. The needle is inserted and advanced toward the notch palpated between the sacral cornu-colas. The needle should penetrate the ligament covering the sacral hiatus and advanced in a cephalic direction, not above the S2 foramen where the dural sac ends (Figures 18-24 and 18-25). The needle can be directed to either side to selectively direct the injectate toward the most affected side. Larger volumes of injectate are necessary to reach the mid lumbar spine, a fact that will dilute the injectate and diminish the selectivity of the injection.

Transforaminal Epidural Steroid Injection

Deposition of a steroid and local anesthetic solution in the ventral epidural space via the intervertebral neural foramen.

Indications The main indication for transforaminal epidural steroid injection is for the deposition of steroids in the ventral epidural space. It is usually performed to treat pain caused by annulus and posterior longitudinal ligament (PLL) pathology such as tears, bulges, and herniations. The transforaminal approach was also shown to be more effective than the interlaminar epidural approach in treatment of pain of patients with spinal stenosis.

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