Bilateral L5 transforaminal epidural steroid injections (CT guided)
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L4/5 disc displacing both descending L5 nerves, resulting in bilateral radicular pain.
Using CT fluoroscopy, 22-gauge Quincke needles were used to gain appropriate positions next to the exiting L5 nerves. Gas as contrast confirmed extra-vascular and epidural needle tip positions. Each side was injected separately and checked with CT, right then left. Subsequent injections of dexamethasone and local anesthetic were given.
Epidural injections can be performed with different techniques, including transforaminal, interlaminar and caudal. Ultimately, epidural 'spill' is desired in all those with radicular symptoms from disc bulges that displace or compress the descending nerve roots. With CT, gas can be used as a contrast agent. Bilateral injections with CT will be quicker and involve less radiation than fluoroscopic guided bilateral injections, owing to the need to perform multiple laterals in fluoroscopy.