Interventional Spine

Humberto, G, Rosas, MD
Louis, A, Gilula, MD, Non ASSR Member
Shane, Inoue, BS, Non ASSR Member
Lee, Kenneth, MD, Non ASSR Member

Paper/Mentor

Purpose

To describe and evaluate a new technique to perform fluoroscopically directed thoracic transforaminal nerve root injections.

Methods & Materials

IRB approval and a waiver of consent were obtained for this retrospective HIPAA compliant study. Fluoroscopic spot views from 198 consecutively performed foraminal nerve root blocks and foraminal epidural injections in the thoracic spine dating back to June 27,1997 were retrospectively reviewed. Via an oblique approach, a curved hand bent needle is placed along the posterosuperior border of the rib inferior to the foramen to be entered. The needle is advanced under fluoroscopic guidance along the course of the rib into the foramen. Specific technical details will be presented.

Results

A single delayed pneumothorax occurred when the prescribed technique was not followed. No other major complications occurred defined as death, neurovascular injury, pneumothorax, puncture of the dura, or infection. Minor complications included vasovagal response (n=1), headache (n=1), lightheadedness (n=2), and transient pain and numbness (n=5) during or following the administration of injectate.

Conclusion

This study describes and evaluates an innovative technique to perform fluoroscopically directed thoracic transforaminal injections, which demonstrated few complications and avoided transgression of structures in the posterior mediastinum by utilizing the rib as not only a conduit into the foramen, but a barrier to non-targeted structures.

References/Financial Disclosures

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