Thoracic Transforaminal Epidural Steroid Injection, Infraneural Approach

Chapter 21 Thoracic Transforaminal Epidural Steroid Injection, Infraneural Approach



Justin J. Petrolla, Michael B. Furman


Although thoracic epidural injections are uncommon, they are indicated for radicular symptoms with or without axial pain that are the result of thoracic spinal etiology. Because of the anatomy of the thoracic vertebrae, the transforaminal approach offers a more specific delivery of medication to the thoracic spine.


Several approaches can be used for a transforaminal injection. In this chapter, we will describe the preganglionic or retrodiscal approach. With this approach, the needle will stay “low in the hole” (i.e., in the lower third of the foramen).


Using the approach described here, the needle is placed with the use of a trajectory view and advanced using multiplanar imaging, with an emphasis placed on safety. The orientation of the zygapophysial joints and the articulation with the ribs makes this a more difficult injection. One must also be aware of the lung fields at all times when performing thoracic transforaminal epidural injections.


Note, the initial trajectory is quite similar to that used for thoracic discography, as described in Chapter 27.


Note: Please see page ii for a list of anatomical terms/abbreviations used in this book.



image Trajectory View




image Trajectory View Safety Considerations


Avoid the spinal nerve by staying inferior in the foramen (i.e., in the lower third).



image Notes on Positioning in the Trajectory View


Maintain the needle in the lower third or “low in the hole.” Do not venture off of the trajectory to avoid contact with the lung field, which is located lateral to the target trajectory.



image Confirm the level (with the anteroposterior view).


image Tilt the fluoroscope caudad or cephalad to optimize endplate visualization.


image Oblique the fluoroscope ipsilaterally (Figure 21–1).


image The C-arm is then obliqued toward the symptomatic side. The needle should be aimed toward the junction of the superior articular process and the transverse process of the inferior vertebrae.

Related posts:

Atlantoaxial Joint Intraarticular Injection Lumbar Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy, Posterior Approach Thoracic Zygapophysial Joint Intraarticular Injection, Posterior Approach Cervical Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy and Nerve Injection, Posterior Approach Thoracic Interlaminar Epidural Steroid Injection, Paramedian Approach Cervical Discography/Disc Access

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Dec 23, 2015 | Posted by in INTERVENTIONAL RADIOLOGY | Comments Off on Thoracic Transforaminal Epidural Steroid Injection, Infraneural Approach

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