2-Minute Lumbar/Thoracic Transforaminal Epidural

[{"selector":"#anim-44da5265-b900-425f-ae72-2bbc2ae7553d","keyframes":{"opacity":[0,1]},"delay":0,"duration":600,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-b3dced52-84b4-489f-a07f-eaae74941318","keyframes":{"transform":["translate3d(0px, 119.37323%, 0)","translate3d(0px, 0px, 0)"]},"delay":0,"duration":600,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] The Procedure Guide

Equipment

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Create a Pointer

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Draw up meds

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Prep Quincke Needle

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Let's treat L4

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Find Insertion Point

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Anesthetize and direct to target

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Walk into TF Space

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Confirm location...

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Confirm location...

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Inject contrast

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Inject Medication

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2 minute time

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Thoracic/Lumbar Transforaminal Epidural

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2-Minute Lumbar/Thoracic Transforaminal Epidural

Equipment

Create a Pointer

Use the longest option that you have, here a 20cc syringe and needle are used (cap on to prevent pokes).

Draw up meds

5cc for subq anesthetic. 3cc total injectate for 2 level TF. Contrast in small syringe.

Prep Quincke Needle

Use desired technique. A sharp angle is used here.

Let's treat L4

Scotty dog view is ideal, but you can work off an AP view as well (as in this guide). Level off endplates (red).

Find Insertion Point

Just lateral/inferior to the inferolateral corner of the TP (green dot)

Anesthetize and direct to target

Aim to contact bone at the bottom of the TP, near lamina (red dot)

Walk into TF Space

Aim inferiorly, walk off bone, advance till you walk off bone and into the TF space.

Confirm location...

The needle should now be in the posterior/superior quadrant of the foramen (from a lateral view)

Confirm location...

A lateral can help confirm this, but often times isn't necessary if the needle barely slipped off bone.

Inject contrast

Inject under live or use digital subtraction to confirm lack of vascular uptake.

Inject Medication

Inject desired medication, about 1.5cc/level.

2 minute time

If things go smoothly, you can treat 1-2 levels within a few minutes. Nice Job!

Thoracic/Lumbar Transforaminal Epidural

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