S1 transforaminal epidural steroid injection (fluoroscopic guided)
Presentation
Ongoing left leg radicular symptoms. MRI showed a left subarticular extrusion at L5/S1 which compresses the descending S1 nerve.
Patient Data
Using a 22 gauge Quincke needle, the posterior S1 neural foramina was cannulated under fluoroscopic guidance and the depth of the needle was guided into position under a lateral projection. Injection of iodinated contrast surrounds the nerve root in the epineural fat.
Subsequent administration of the steroid containing injectate dilutes the already given iodinated contrast with further opacification along the course of the S1 nerve.
Case Discussion
S1 transforaminal epidural steroid injections can be challenging. A simple technique to optimize finding the posterior neural foramina is obliquely angulating the tube away from the midline, much like finding the 'Scotty dog' position for the lumbar nerve root injections. Iodinated contrast should be easy to inject and care must be taken to identify inadvertent injection in a vessel, which is more frequent with S1 injections.
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