The technique of lumbar transforaminal injection for radicular pain. C arm medley series 2

I will share several lumbar interventional procedures for the radicular pain in the C-arm medley.

This medley is designed to help beginners and intermediate experts perform better practices.

The technical difficulties are diverse depending on the morphology and deformity of the lumbar spine.

You will learn how I approach the target and solve the challenges.

Let me present the fourth case.

It is a more challenging case compared to the previous one.


I will show you how I approach selecting both L5 nerve root

with supportive L4 root and L4-5 facet joint injection.

Let me turn to the ipsilateral oblique view.

It has a clear margin and opening.
Give me an AP view.
She is expressing electric sense.
So, I have to change the direction.
Give me a contralateral oblique view.
Let me administer contrast media.
The contrast spread looks good to me.
I will deliver steroid mixture.
She is expressing pain. Do not ignore the patient’s reaction.
So, I must slow down the injection speed
If the contrast pattern is good, I don’t need to relocate the needle. Otherwise, think twice.
let me go to the right oblique view. The target is unclear.
Please turn more. The window is clearly visible.

I must puncture the more lateral skin in this situation,

and the inclination angle will be flat.
Look at the needle angle.

Keep in mind the right side is more challenging than the left side.
Take out your hand during the x-ray is on.

Let me show an AP view.
Let me show you the contralateral oblique view.

I think the contralateral oblique view provides better needle orientation

and saves time with a reduction of scattered radiation than the lateral view.

I will confirm with contrast media.
Take away your hand from the x-ray beam.
The contrast spread looks good.
Please give me an AP view.
I will deliver the steroid mixture.
There is central stenosis at the L4-5 level.
Therefore, I want to add both L4-5 facets joint injections to

facilitate the relief of compressive symptoms.
To facilitate the therapeutic effect,
I will try to insert the needle into the inferior posterior recess of the left L4-5 facet joint first.
The suspected inferior recess line is here.
I think the proliferation of marginal spur obstructs the needle pathway.
Though, let me check the needle placement.
The contrast pattern shows extra-articular space.
I will go straight to the upper anterior recess of the left L4-5 facet joint.
The illustration shows the anterior superior articular recess of the facet joint
I will administer the contrast media.
The needle did not reach the joint capsule, and it shows the contrast intravasation.
The contrast spills into the epidural space. I overpassed the joint capsule.
I regret it. I should have to take time and observe the needle depth via the contralateral oblique view.
But the epidural injection is not bad for supplement treatment.
Let’s move on to the right L4-5 facet joint injection.
Give an ipsilateral oblique view.
It is the imaginary line of an inferior recess of the facet joint
I will check the needle location by the contrast spread
The contrast pattern looks good.
I will deliver the steroid mixture into the right L4-5 facet joint.
Thank you for watching. See you in the following videos.




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