Intravascular needle tip position during a S1 transforaminal epidural steroid injection
Presentation
For S1 TFESI, as failed conservative measures and nerve compression on prior MRI.
Patient Data
A 22 gauge Quincke needle was used to gain an appropriate positioning, after passing through the dorsal foramina. The lateral image confirms the appropriate depth of the needle, at the level of the dorsal cortex of the sacral vertebral body.
Injection of iodinated contrast whilst continuously screening with a frontal view demonstrates the needle tip is within a vessel.
The needle was subsequently repositioned, and further administration of contrast confirms the needle is now in an epidural position, with the contrast extending cranially towards the L5/S1 disc. The final still image capture is taken after the steroid injectate was given, with the dispersion of the contrast.
Case Discussion
Contrast should be given to confirm the needle tip position in fluoroscopic procedures. S1 transforaminal epidural steroid injections are notorious for encountering vessels, and when a vessel is injected, the contrast will quickly disperse, and often the contrast will travel laterally. Epidural injections tend to be more blotchy and travel along the course of the nerve, ideally towards the disc if the nerve is compressed at the disc level.
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