How medial do you advance the needle for a good LTFESI?

[cameroncarter]

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The Kumar Technique: A Novel and Effective Approach to Transforaminal Epidural Steroid Injections

Background Transforaminal epidural steroid injections (TFESIs) are widely used as a minimally invasive treatment for lumbar radicular pain. This study presents an alternative approach for lumbar TFESI, the Kumar Technique, which utilizes a more lateral and inferior needle starting point to...

www.cureus.com

I always stop lateral to the mid-pedicular line, but this article suggests that placing the needle further medially may be more effective?

 

[nvrsumr]

Approach Looks pretty standard for my higher level ltfesi. I don’t end up that medial but usually save a final oblique view rather than ap

 

[BobBarker]

I think Dr Kumar is really reaching with this one.

 

[pmrmd]

I should have published the obvious long ago and had an eponymous shot. High lumbar injections—L3-4 and above—require this starting point or else your needle tip will end up being forced inferiorly when getting into the foramen.

 

[cameroncarter]

I should have published the obvious long ago and had an eponymous shot. High lumbar injections—L3-4 and above—require this starting point or else your needle tip will end up being forced inferiorly when getting into the foramen.

I don’t mind the starting point, but wouldn’t ending that medial risk thecal sac punctures?

 

[pmrmd]

I don’t mind the starting point, but wouldn’t ending that medial risk thecal sac punctures?

Stop at 6 o’clock or just lateral. But need to have cephalad approach angle at L3-4 and above

 

[Ducttape]

retrospective study so take it for what it is worth.


does seem more risk of dural puncture as noted above. generally risk of PDPH from TFESI is exceedingly low...


seem more fluoro needed to obviate that risk. its not like he can judge depth or anything that might impact depth using this technique without switching back and forth

 

[clubdeac]

Stop at 6 o’clock or just lateral. But need to have cephalad approach angle at L3-4 and above

What do you mean by cephalad approach? In higher TFESIs my approach is inferior to superior as my c-arm is slightly angled caudad to square off the end plates. I do enter as high as I can in the foreman however

 

[pmrmd]

What do you mean by cephalad approach? In higher TFESIs my approach is inferior to superior as my c-arm is slightly worked caudad to square off the end plates. I do enter as high as I can in the foreman however

That’s what I mean. Agree.