Flouro Images of Lumbar Spine Injections

David F. Drake, MD

Director, VCU PM&R Pain Fellowship

David Berkower, MD

2003-4 Pain Fellow

Using Contrast Dye

• The following views were obtained using an injection dummy and therefore no contrast dye was used.

• We recommend, when available, the use of contract dye to confirm needle placement

Lumbar Median Branch Block (MBB)

The flouro is placedin the oblique positionat approx 30 degreesto view the “scotty dog”.The needle is directed atthe eye of the “scottydog” and advanced untilbone is contacted.

Needle

Lumbar Facet InjectionA lumbar facet injection would be done in a similar fashion as a MBB, however the target is the facet joint (between the ear of the lower “scotty dog” and the front foot of the upper “scotty dog”).

Sacroiliac InjectionThe flouro is placedjust off AP in order toalign the inferior polesof the SIJ. The needleis advanced into theinferior poles until aloss of resistance isappreciated.

Needle

AP View of Lateral Hip InjectionThe lateral hip approach avoids the nerves and vessels which may be encountered in the anterior approach. It’s wise to get a lateral flouro view to confirm needle placement.

AP View of Anterior Hip Injection

When performing a hipinjection from the anterior,the artery should be palpatedat all times and gentlenegative pressure (aspiration)in the syringe is important toavoid intravascular injection.

AP View of Anterior Hip Injection – Part 2

A different view

Oblique View of Lumbar Transforaminal Epidural

Place the flouro in the oblique position (approx 30 deg). Focus the needle under the chin of the “scotty dog” [superior aspect of lateral foramen].

Needle

Lateral View of Lumbar Transforaminal

Obtain a lateral view toconfirm needle is w/inthe foramen.

AP View of Lumbar Transforaminal

Finally, obtain an AP viewTo confirm the needle isMedial enough and w/in theEpidural space.

*Note: for a selective spinalnerve injection the needleshould be more lateral and not w/in the epidural space.

Oblique View of Disc InjectionThe flouro is placed in theoblique position [approx30 deg]. The needle isadvanced into the discspace. A firm, fibrous sensation is often felt when entering the disc.

Lateral View of Disc Injection

A lateral flouro view isobtained to confirmneedle depth.

AP View of Disc InjectionAn AP view may be obtained to assess how medial the needle is.

Oblique Lumbar Sympathetic Block

An oblique flouro view[approx 30 deg] is obtained.The needle is directed justanterior to the L-3 vertebral body.

Needle