The Handbook of C-Arm Fluoroscopy-Guided Spinal Injections

by Wang, M.D., Ph.D.; Linda Hong

• ISBN13: 9780849322549
• ISBN10: 0849322545
• Format: Hardcover
• Copyright: 2006-01-13
• Publisher: CRC Press

Summary

For some time now, C-arm fluoroscopy-guided spinal injections have been performed widely for both the diagnosis and management of spinal and paraspinal pain. Despite this common use, many residents and pain fellows do not receive any training in the anatomy of the vertebral column as it relates to radiographic imaging, nor do they receive training in fluorscopic imaging. While books already exist on the subject, they only show the final needle position and offer very limited instruction.

Table of Contents

An Introduction to Spinal Injections	1	(4)
Basic Radiographic Background of the Vertebral Column	5	(24)
C-Arm Fluoroscopy and Images	7	(6)
Axial Skeleton	13	(5)
Anatomy of a Typical Lumbar Vertebra	15	(2)
Pelvic Girdle and Sacrum	17	(1)
Classification of Bones and Typical Fluoroscopic Images of Bones	18	(9)
Bibliography	27	(2)
Radiation Safety	29	(12)
Quantification of Radiation Exposure	31	(1)
Steps to Minimize Radiation Exposure	32	(7)
Shielding	39	(1)
Bibliography	39	(2)
Basic Steps for Spinal Injections	41	(14)
Bibliography	54	(1)
Fluoroscopic Images of the Lumbar Spine	55	(16)
Positioning the Patient	57	(1)
Anterior/Posterior View of the Lumbar Spine	57	(2)
Oblique View of the Lumbar Spine	59	(3)
Lateral View of the Lumbar Spine	62	(5)
Suggestions on How to Check the Needle Depth	67	(2)
Bibliography	69	(2)
Lumbar Spinal Injections	71	(80)
Lumbar Spinal Injections	73	(1)
Lumbar Medial Branch Block	73	(15)
Lumbar Medial Branch Denervation	87	(1)
Lumbar Transforaminal Epidural Steroid Injection	88	(7)
Special Considerations of Oblique Views	94	(1)
Rules for Getting Oblique Views of the Lumbar Spine	95	(16)
Lumbar Transforaminal Epidural Steroid Injection at the Level of L5/S1	111	(13)
Lumbar Discography	124	(3)
Introduction	124	(3)
Manometry	127	(14)
Patient Preparation	127	(1)
Sedation	127	(1)
Preparation for Needle Placement	128	(1)
Patient Position	128	(1)
C-Arm Position	129	(1)
Needle Placement	130	(2)
Potential Difficulties with Needle Placement (Annular Placement of the Needle)	132	(4)
Contrast Injection within the Disc Space	136	(5)
Mechanically vs. Chemically Sensitive Discs	141	(1)
Discography at L5/S1	141	(6)
Positioning C-Arm Fluoroscopy	142	(1)
Needle Insertion	142	(3)
Confirming the Needle Placement	145	(1)
Injecting Contrast	146	(1)
Post-Procedure	147	(1)
Bibliography	148	(3)
Fluoroscopic Images of the Cervical Spine	151	(18)
Positioning the Patient	153	(1)
Positioning the C-Arm Fluoroscopy	154	(1)
A/P (P/A) View and Lateral View of the Cervical Spine	155	(1)
Comparison of Cervical Vertebrae and Lumbar Vertebrae	156	(2)
Lateral and Oblique Views of the Cervical Spine	158	(7)
Cervical Intervetrebral Foramina and the Cervical Spinal Nerve Roots	165	(2)
Bibliography	167	(2)
Cervical Injections	169	(52)
Preparation for the Performance of Cervical Injections	171	(1)
Cervical Facet Injections	172	(2)
Intra-Articular Facet Injections	174	(17)
C1/C2 Joint Injection	174	(6)
C2/C3 to C6/C7 Intra-Articular Joint Injections	180	(6)
Cervical Medial Branch Injections	186	(5)
Cervical Medial Branch	191	(5)
Radiofrequency Denervation	191	(1)
Radiofrequency Denervation: (C3 to C8) Medial Branches	192	(4)
Cervical Epidural and Selective Nerve Root Injections	196	(22)
Cervical Transforaminal Injections	196	(2)
C2 Dorsal Root Ganglion Injection	198	(3)
C3 to C7 Transforaminal Injections	201	(9)
Selective Nerve Root Injection or Epidural Steroid Injection	210	(6)
Interlaminar Epidural Steroid Injections	216	(2)
Bibliography	218	(3)
Fluoroscopic Images of the Sacrum and Pelvis	221	(8)
Posterior View of the Pelvis and the Sacrum	223	(1)
A/P View of Fluoroscopic Image of the Sacrum	224	(4)
Bibliography	228	(1)
Pelvic and Sacral Injections	229	(18)
Sacroiliac Joint Injection	231	(7)
Caudal Epidural Steroid Injection	238	(8)
Bibliography	246	(1)
Sympathetic Blocks	247	(22)
Stellate Ganglion Block (Right Side)	249	(4)
Lumbar Sympathetic Block	253	(8)
Superior Hypogastric Plexus Block	261	(6)
Bibliography	267	(2)
Index	269