Cervical transforminal epidural steroid injection (CT-guided)
Left arm radicular pain. Previous transforaminal injection worked well.
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Stages of a left C5-6 TFESI, with an overlying grid to mark the skin entry point on the initial planning images. Images were acquired and saved pre and post-injection of iodinated contrast, with the injected contrast extending into the extra-foraminal, foraminal, and epidural spaces. A 25G needle was used to access the foramina.
The vertebral artery has a closer relationship with the foramen in the mid-cervical levels, less so at C7-T1. Injection of iodinated contrast will further identify the position of the needle tip, before administering the steroid containing injectate, as in this case, 10mg dexamethasone, a non-particulate steroid, mixed with 1mL 1% lidocaine.