The Procedure Guide

2-Minute Lumbar/Thoracic Transforaminal Epidural


01 5cc subq anesthetic in 5cc syringe with 25g x 1.5" hypodermic

02 Bent 22g (3.5" or 5") Quincke Needle

03 0.125% bupivacaine mixed with dexamethasone: about 1.5cc total volume (per level)

04 Radiopaque pointer 

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.

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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