Devoted to diagnostic and interventional spine imaging and therapeutics


Dual Puncture Technique for Interlaminar Approach to Lumbar Epidural Steroid Injection 2011

Interventional Spine

Orlando, Ortiz, MD, MBA
Allison, Rubin, MD, Non ASSR Member



To illustrate the utility of a dual puncture technique to facilitate therapeutic lumbar epidural steroid injection

Methods & Materials

Several cases are demonstrated in which patients underwent fluoroscopy guided lumbar epidural steroid injection. In each case, the initial spread of contrast agent during epidurography into the lumbar epidural space was limited. In each case subsequent epidural steroid injection was not effective at alleviating back pain symptoms at 3 weeks. The procedure was then repeated using two separate puncture sites for epidural space access. Epidurography with a low osmolar nonionic contrast agent was performed to confirm a more satisfactory spread of contrast agent about the level of suspected pathology. This was followed by epidural steroid injection.


Dual puncture lumbar epidural steroid injection was safely performed in all of the patients. Lumbar stenosis was present in 3 patients; post-surgical adhesions due to prior laminectomy were present in another patient. Each patient experienced a therapeutic benefit defined as greater than 3 point reduction in their numeric pain score.


Dual puncture interlaminar epidural steroid injection can be an effective technique in the management of patients with low back pain in situations where the distribution of medication into the epidural space may be compromised (due to stenosis, adhesions or anatomic variants in the epidural space) as demonstrated on epidurography.

References/Financial Disclosures

Ranson MT, Deer TR. Epidural injections for the treatment of spine-related pain syndromes. In Mathis JM, Golovac S (eds). Image-Guided Spine Interventions. 2nd edition. New York: Springer, 2010: 157-174 Financial Disclosures: O Ortiz â