True lateral imaging during lumbar medial branch radiofrequency neurotomy: Interobserver reliability.

Background: True lateral imaging (TLI), obtained by superimposing bilateral lumbar spine structures and aligning superior endplate cortical bone, requires deliberate rotational adjustments of the laterally positioned fluoroscope in both the axial and longitudinal planes. True lateral segmental imaging is necessary to depict true and accurate radiofrequency (RF) cannula positioning relative to bony anatomy during lumbar medial branch radiofrequency neurotomy (LMBRFN).

Objective: To determine the interobserver reliability of TLI during LMBRFN.

Encephalopathy after unintentional intrathecal gadolinium: A letter to the editor.

Objective: Raise awareness of gadolinium encephalopathy, a rare cause of neurological symptoms.

Setting: An L5-S1 interlaminar epidural steroid injection (IL-ESI) was performed with a gadolinium-based contrast agent (GBCA) due to the patient's history of allergic reaction to iodine-based contrast agents.

Discussion: Several hours after administration of GBCA, the patient had nausea and vomiting with altered mental status.

A proposed nomenclature for spinal imaging and interventional procedural reporting.

Objective: To develop precise universal standard interventional spine nomenclature for reporting procedural details and anatomy.

Methods: There is no comprehensive nomenclature of spinal imaging anatomy that can be used for anatomical and procedural reporting. Given this critical lack of unifying terminology, a system of nomenclature was developed de novo by expert consensus, based upon clinical needs, and previously published reports.

Induced lumbosacral radicular symptom referral patterns: a descriptive study.

Background Context: Lumbosacral radicular symptoms are commonly evaluated in clinical practice. Level-specific diagnosis is crucial for management. Clinical decisions are often made by correlating a patient's symptom distribution and imaging with sensory dermatomal maps.

Lumbosacral Transitional Segments: An Interventional Spine Specialist's Practical Approach.

The presence of a lumbosacral transitional vertebrae (LSTV) should prompt a more detailed preprocedural evaluation of the vertebral column to accurately determine spinal levels. An LSTV should prompt the use of corroborating intraprocedural imaging to verify morphology. The most important factors in treating lumbosacral transitional segments are communication among treating physicians to ensure segmental enumeration consistency and associated appropriate patient treatment.

Image and Contrast Flow Pattern Interpretation for Attempted Epidural Steroid Injections.

Fluoroscopically guided, contrast-enhanced epidural steroid injections (ESIs) are frequently performed for radicular symptoms. Interventionalists performing these procedures should have a thorough and detailed understanding of spinal anatomy to safely and effectively deliver the desired injectate to the targeted site. Being able to differentiate epidural from nonepidural contrast flow is vital as is recognizing flow to undesired locations.

Fluoroscopic contralateral oblique view in interlaminar interventions: a technical note.

Objective: To describe the value and utility in using a contralateral oblique (CLO) view when performing cervical, thoracic, and lumbar interlaminar procedures including epidural steroid injections and spinal cord stimulation percutaneous lead placement.

Methods And Results: Fluoroscopic images are used to illustrate the value of using CLO views. The CLO view is obtained after the level is confirmed.

Injectate volumes needed to reach specific landmarks in s1 transforaminal epidural injections.

Objectives:   We identify the contrast volumes needed to reach specific landmarks during S1 transforaminal epidural injections (S1-TFEIs).

Design:   Prospective, nonrandomized, observational human study. Setting.

Discography's role in low back pain management.

SUMMARY Lumbar provocation discography is a commonly used diagnostic procedure utilized to determine the presence or absence of discogenic pain at a specific spinal segment. Although multidisciplinary societies have recognized discography as the primary criterion for identifying discogenic pain, the test remains controversial. Skeptics argue against its sensitivity and specificity, and suggest that it's risks outweigh any potential benefits.

Efficacy of fluoroscopically guided, contrast-enhanced lumbosacral interlaminar epidural steroid injections: a pilot study.

Objective: To assess the efficacy of fluoroscopically guided, contrast-enhanced lumbar interlaminar epidural steroid injections (IL-ESI) for lower limb pain greater than axial low back pain using self-reported pain scores.

Study Design: Prospective, single-arm, pilot, observational human study.

Setting: An outpatient private practice interventional spine specialty referral center.

Injectate volumes needed to reach specific landmarks in lumbar transforaminal epidural injections.

Objectives: To identify the volumes of contrast material needed to reach specific landmarks during lumbar transforaminal epidural injections (L-TFEIs).

Design: Prospective, nonrandomized, observational human study.

Setting: Academic/private pain management practice.

Contrast flow selectivity during transforaminal lumbosacral epidural steroid injections.

Background: Lumbosacral transforaminal epidural steroid injections (LS-TFESIs) are an accepted procedure used in the comprehensive, conservative care for lumbar disc pathology and/or spinal stenosis induced low back pain with a radicular component. Historically, the terminology used to describe the transforaminal technique of instilling medications into the epidural space and/or exiting structures has varied. These procedures have also been referred to as either diagnostic or therapeutic selective nerve root blocks (SNRBs).

Fluoroscopic axial imaging in percutaneous lumbosacral procedures: An underutilized technique.

Background: The L4-5 and L5-S1 intervertebral disc spaces are the most frequent sites of discal spinal pathology, hence, diagnostic and therapeutic interventions are commonly performed at these levels. While performing fluoroscopically guided spinal procedures such as discography or intradiscal electrothermal anuloplasty (IDEA), antero-posterior (AP), lateral, and oblique views are utilized. However axial projection is not typically possible without three-dimensional imaging such as computerized tomography (CT).

Incidence of intravascular penetration in transforaminal cervical epidural steroid injections.

STUDY DESIGN A prospective, observational, human, study was conducted. OBJECTIVES To evaluate the incidence of vascular penetration during fluoroscopically guided, contrast-enhanced transforaminal cervical epidural steroid injections, and to determine whether the observation of blood in the needle hub can be used to predict a vascular injection. SUMMARY OF BACKGROUND DATA Incorrectly placed intravascular cervical spinal injections result in medication flow systemically and not to the desired target.