I will share several lumbar C-arm interventional procedures for the radicular pain in these medley series.
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 fifth case.
I will show you how to select the right L5 and S1 nerve roots.
Let me turn to the ipsilateral oblique view.
Again, please use the advantage of long forceps for your hand protection.
I will put the needle in a standard position.
I switch to my bare hand when the needle movement straight.
Usually, it matches the deep muscle penetration.
Please change to AP view if the needle touches the intertransverse ligament.
and redirect the needle along the inferior margin of the pedicle.
Please fine-tune the final needle position by the contralateral oblique view.
Please confirm the space with the contrast media
The contrast spread looks good.
I will deliver the steroid mixture.
The next target is the right S1 posterior foraminal space.
Usually, the S1 nerve root is supposed to be compressed by subarticular stenosis at the L5-S1 disc level.
The proper identification of the posterior hole of S1 is the crucial point of successful needle placement.
The posterior hole margin is fainter than an anterior hole and is located in the upper medial aspect.
Identifying the needle penetration depth is also a crucial factor to succeed the procedure.
Use your imagination and draw an imaginary line.
Let me present the sixth case.
It is a case of left L4-5 severe foraminal stenosis.
I will deliver the steroid mixture into the left L4-5 foraminal space with the botulinum mixture into the L4-5 facet joint.
Please note the C arm angle. It shows caudal angulation to align the inferior endplate of L4.
Please note the transverse process and superior articular process of the L5 vertebra.
I try not to go to the subpedicular space because it is a case of foraminal stenosis.
Let me confirm with the contrast media.
It shows the intraneural spread of the contrast media.
My patients complain more pain when the contrast spread shows intraneural infiltration than the perineural injection.
Therefore, I try not to administer the drug if the patient answered it is painful.
I withdrew a little, and the patient did not feel pain,
so I will deliver the steroid mixture carefully, monitoring the patient’s responses.
The next target is the left L4-5 facet joint.
I will approach inferiorly, targeting the inferior recess of the L4-5 facet joint.
Observe the apparent margin of the inferior border of the L4 inferior articular process.
It shows the filling of the facet joint and leaking superior laterally into the foraminal space.
It means the underlying capsular tear in the superior anterior recess.
I will deliver the botulinum mixture into the facet joint space.
Let me present the seventh case. It is a challenging case.
My target will be the right L5 and L4 nerve roots.
I will show you an ipsilateral oblique view.
Osteoporosis, disc space narrowing, marginal spurs are common features of elderly patients.
Let me show you the contrast lateral oblique view.
Let me confirm with the contrast media. I will advance the needle a little bit.
The contrast spread looks good.
I will deliver steroid mixture.
The next target is the right L4. let the C-arm angle caudally align the L4 inferior endplate.
The inferior border of the L4 transverse process looks faint and inferior protruded, which will be the obstacle.
It isn't easy to find a suitable entry point.
Please give me a contralateral oblique view.
Let me test with contrast media.
I can watch a contrast leaking into the disc space.
This contrast spread is frequently noted in the degenerated protruded disc.
So, sterile preparation is essential for the prevention of infection.
Thank you for watching. See you in the following videos.
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#이미지트레이닝 #만성통증 #통증 #초음파시술 #초음파 #시술 #안전한시술
26 авг 2024
