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I still have trouble with these. I start AP, enter 1-2 levels below the target joint, swing contra-lateral oblique, advance, shoot contrast, get a blobby looking mess, start over again... 😡
Any good Fluoro Shots of IA thoracic facet injections...
- Thread starter drusso
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I don't understand the "contralateral oblique" part. I use an AP view and sometimes a lateral view.
If you look at a spine model you'll see that the inferior aspect of the joint is at about the level of the pedicle.
Enter about 2 levels below. Using a curved-tip needle hit the inferior aspect of the pedicle shadow with the curve pointing down onto the bone surface. This should put you at either the inferior part of the joint or the superior edge of the lamina. Then turn the needle 180 degrees and advance, sliding along the anterior surface.
With a little contrast you should see a circle between the upper and lower pedicle shadows.
If that doesn't work, go back to hitting the inferior pedicle shadow and after making bony contact go to a lateral and make sure you're hitting the right spot, then flip the needle and slide along the anterior joint surface. Sometimes you hit the lamina above the joint. And sometimes you just can't enter the #$%*%&@$##$% joint.
In the upper thorax I enter 1 to 1.5 levels below because the angle changes. The approach angle is extremely important for entering these joints.
If you look at a spine model you'll see that the inferior aspect of the joint is at about the level of the pedicle.
Enter about 2 levels below. Using a curved-tip needle hit the inferior aspect of the pedicle shadow with the curve pointing down onto the bone surface. This should put you at either the inferior part of the joint or the superior edge of the lamina. Then turn the needle 180 degrees and advance, sliding along the anterior surface.
With a little contrast you should see a circle between the upper and lower pedicle shadows.
If that doesn't work, go back to hitting the inferior pedicle shadow and after making bony contact go to a lateral and make sure you're hitting the right spot, then flip the needle and slide along the anterior joint surface. Sometimes you hit the lamina above the joint. And sometimes you just can't enter the #$%*%&@$##$% joint.
In the upper thorax I enter 1 to 1.5 levels below because the angle changes. The approach angle is extremely important for entering these joints.
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It's practically a lateral view. I use it in the upper thoracic T4 and higher. I use the CLO view for my cervical interlams. One day I noticed I could see the facet line nicely in the upper thoacic spine so I started to experiment with it.
Drusso, I use the approach from the back of the ISIS book, it works well. Square the endplates and bring the needle almost straight down in AP (or maybe just a few degrees of caudal tilt) to the superior pole of the midline of the pedicle, then swing to the oblique. I had great success using the contralateral oblique view like you describe, but you really are almost lateral (80 degrees contralateral oblique) to best visualize the facet. You will see on the lateral that if you come in too far caudal you won't get in the joint. Adjust the needle to the inferior recess on the lateral, go back to AP, then shoot your dye. Much easier than I would have imagined. I'll see if I have some pics.
