Originally Posted by DocShark
i disagree. i understand that a L5-S1 disc herniation, more central, is likely to compress the S1 nerve, and when i do L5-S1 TFESI, I do get L5 spread, but I usually get more S1 spread. More than anything the bulk of the medication is placed at the site of the compression, at the level of the disc, IMHO. I rarely do S1 TFESI. I have, but basically stopped as i didnt think the results were as good at L5-S1. I typically treat S1 radics with L5-S1 TFESI, and get appropriate results in m opinion. I go at the level of the disc. This is my approach at least, as well as my partners, and many other people i know. But i agree, many ways to skin a cat.
I see your point. I do sometimes see the contrast flow towards the midline in addition to flowing cephalad.
I still think an interlaminar at the level of the herniation is likely to miss though.