The Procedure Guide
Normally there are 5 lumbar vertebrae, but everyone's anatomy is slightly different. Compare to CT/MRIs to see what numbering they use
Positioning, scoliosis, anatomic variation will cause variation in C-arm orientation. Just stick to the principles outlined in the following slides...
Spinous processes mostly aligned vertically and midline (blue). Target here is sacral ala with the needle so the top of sacrum is leveled off (red)
Level endplates at the level that you are working at. In this example L5 is NOT leveled off (green outlines the anterior and posterior margins of the endplate). Instead the sacrum is leveled off (red)
Front half of scotty dog outlined (green), superior endplate of L4 is flat (red), the L3-L4 joint is “down the barrel” so it’s translucent (blue).
To get this view: - Start with an AP view - Level off the desired endplate - Oblique left/right till you get the scotty dog
Level endplates so the vertebrae have a "box" like appearance. Well outlined neuroforamen.