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 demonstrate the first case
The left L5 targeting is more accessible than the right one
because of the excellent delineation of the inferior border of the transverse process
and the narrow clear lateral border of the articular process.
The right L5 is more challenging
because of the downward curvature of the inferior border of the transverse process
and laterally protruded articular process.
left ipsilateral oblique view.
I have a clear view of a safe triangle.
I will place the needle at the standard textbook spot, inferior-lateral aspect of the safe triangle.
I noticed that the inferior border of the pedicle
and the inferior border of the transverse process looks overlapping at the medial corner.
This figure suggests an easy approach from the puncture site to the 12 o’clock position of the pedicle directly.
It allows me to advance the needle close to the inferior border of the transverse process on AP view.
Let me turn to the contralateral oblique view.
Nothing stops me from close moving the needle along the inferior border.
The contrast spread looks good.
Let me turn to AP view.
The right approach is challenging than the left one.
Let me turn to the right ipsilateral oblique view.
The inferior border of the transverse process is placed caudal to the
line of the pedicle and downward protrusion of the transverse process.
I can’t go directly into the target point with a standard technique.
Need to place the needle more inferior and lateral from the usual target point
Let me turn to AP view.
If my needle trajectory is too flat, I may hit the lateral border of the bony structure,
failing to go the foraminal target.
So, make sure to make enough needle slope.
I ask her to rotate the c-arm to contralateral oblique view.
The inferior border of the pedicle is clear.
It is the lateral border of the inferior articular process.
I have to underpass the bony line.
The contrast pattern is OK.
Let her put the C-arm AP view.
Does the contrast pattern look like a mustache?
I will demonstrate 2nd case.
It is a little more challenging. The prominent spurs of the superior articular process will be an obstacle on both sides.
let me ipsilaterally rotate c-arm. I may have to move more to visualize the safe triangle.
Of course, the skin puncture site will be more lateral than the standard point.
But I try not to go close to the lateral border of the superior articular process.
Let me show you the AP view.
A slight twist of the needle turns the direction of the needle toward the target.
Let me show you the contralateral oblique view.
It is the lateral border of the articular process. I need to pass under this border.
Let me administer contrast media.
The contrast spreading pattern is good.
Let me show you the AP view and deliver the steroids.
I insist on a Luer lock type instead of an ordinary disposable plastic syringe.
The fluid frequently bursts out at the connection of the disposable syringe
because of the high viscosity of contrast media and dextrose.
Luer lock prevents unexpected blasts.
Let me go to the right ipsilateral oblique view.
I may have to ask more angulation than you expected.
The procedure for the right side is more challenging to control the needle
because I must move the needle from out to inside.
I should focus on needle orientation more.
I should consider the degree of the C-arm oblique angle and cranial tilting angle
while I watch the needle and needle shadow.
The long placenta forceps is very handy to reduce radiation hazard.
I can control the needle direction and move forward
by twisting, gentle pushing, and sometimes bending the needle shaft.
I will show you the AP view.
Contralateral oblique
The curved line may be the lateral border of the articular process.
Looks good
AP view
I hold the spinal needle while I push the piston of the syringe.
It prevents displacement of the needle.
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#이미지트레이닝 #만성통증 #통증 #초음파시술 #초음파 #시술 #안전한시술
16 июл 2024
