It is the partial version of the full video of C-arm guided thoracic transforaminal epidural steroid injection technique.
Today, I will show you a thoracic transforaminal epidural steroid injection technique.
I will perform it under C arm Ap, ipsilateral, and contralateral oblique image guidance.
My target will be the T9 right intervertebral foraminal space and countdown from the T12 body.
It is the T9 level, and I found a large osteophyte formation on the right side.
The thoracic spine is a very stable structure built by multiple mechanical supporters, such as multiple symmetric ribs, robust transverse process, tight bond between the rib and transverse process, and wide laminar. So, there is less chance of herniation of nucleus pulposus and the nerve root compression than other levels. I have to admit that I have faced some technical difficulties
because I had less chance of practice and little experience before finding the advantage of a contralateral oblique image. More factors make me challenge. First, kyphotic thoracic curvature.
In the upper thoracic region, I have to tilt the C-arm cranially to make the end plate flat alignment.
Please don't confuse the terminology. Usually, I place the image detector on the table and x-ray generator under the table. I put the name "cranially" by the direction of the x-ray generator, not the image detector. In the middle thoracic region, I can put the C arm neutral direction. In the lower thoracic region, I have to tilt the C-arm caudally. With the aging process, the kyphosis becomes severe, and cranial and caudal angulation of the C arm becomes bigger. It means technical difficulties.
The 2nd factor is the multiple bony structures that block the needle pathway. The rib, transverse process, and wide lamina are the culprits.
The 3rd, Osteoporosis.
it becomes translucent and makes me challenge to detect the bony landmark structures
The laminas are vertically oriented and compactly wrapped in layers. And there is only slit like interlaminar space in the thoracic spine. So, there is no alternative way to reach the epidural space,
unlike the cervical and lumbar spine. The transforaminal approach is the best way.
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26 авг 2024
