Difficult Lumbar TFESIs

[RoloTomassi]

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How far ventral are you guys going for the S1 TFESI on lateral view? Furman says "base of the sacral canal", but almost every picture I see shows the needle ventral to that point

Posterior border of sacrum

 

[CleanUp]

My dumb@ss not taking my own advice on sticking to caudals. Still 95% improved two weeks later. Never again.

I looked at her X-ray and thought it would be ok but forgot about the IPG getting in the way on oblique. SCS from me, vertiflex and fusion from the neurosurgeon.

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I don’t see any hardware

 

[runfastnow]

Trust me, it's not any better. It's probably the biggest motivator for me leaving the military. They have unrealistic expectations, poor procedural tolerance, and lots of secondary gain issues.

I much prefer my 85 year old retired generals who show up in suit and tie.

Totally agree - I see a ton from the local VA and my experience is exactly the same.

 

[Ducttape]

Trust me, it's not any better. It's probably the biggest motivator for me leaving the military. They have unrealistic expectations, poor procedural tolerance, and lots of secondary gain issues.

I much prefer my 85 year old retired generals who show up in suit and tie.

um...


right now, the 30 year olds i get have bmis > their age.

My dumb@ss not taking my own advice on sticking to caudals. Still 95% improved two weeks later. Never again.

I looked at her X-ray and thought it would be ok but forgot about the IPG getting in the way on oblique. SCS from me, vertiflex and fusion from the neurosurgeon.

good job, looks real challenging.

i usually offer bilateral S1 TFESI in this situation. i might try more caudals.

 

[MitchLevi]

From yesterday.

BTW, angle towards the superomedial aspect of the foramen and your injectate will travel farther. Use a 25g needle. Play Fleetwood Mac. Entertain the pt with tales of battle and high adventure.

 

[epidural man]

Anyone able to post pics of their needle entry point(s) for L5 and S1 TFESIs? I have been getting poor epidural spread lately and need to look at my technique again.

I don't know if this helps -

But tilt the image intensifier very cephalad until there is a good-sized opening between the pedicle and the facet, then hug the pedicle and lamina, passing over the facet (Camera should be rotated until you can't rotate anymore from iliac crest or 30 deg or something like that).