great points.
contrast with MBB is critical. Avoiding vascular uptake is nice but the biggest reason is to verify that that your medication covers the MBB. 2nd is that Medicare MBB require contrast to be paid.
Without contrast, you‘d be amazed how often you miss. I trained with the North American expert on MBB/RFA, Paul Dreyfuss, and we regularly saw patients who failed RFA after MBB, and when we reviewed the MBB images, we saw either needles out of position, no contrast, or contrast clearly not covering the MBB. Rather sad how little time many docs spend to treat the humans depending on them for pain relief.
agree with Taus on IL VS TF.
I also trained lumbar ESI 80/20 TF/IL, but I now do 30/70, (including caudals). I still start with TFESI for acute radic, but I now use ILESI or S1 vs S2 TFESI with depo as first ESI for every thing else, (stenosis, spondylolithesis with radic, recurrent radic with stenosis and/or recurrent/degenerative disc bulge).
This year, I took over the practice of a physician who retired. He was a good doc, but followed SIS protocols blindly. 95% of his lumbar ESI were TFESI with dex. Most his patients over 50 with a component of stenosis achieved great relief.....for 1-2 weeks. I repeated about 30 of those epidurals as ILESI or S1 with depo, and over 80% Of those patients still have 80% relief now 4 months Later.
