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Optimal Angle of Needle Insertion for Fluoroscopy-Guided Transforaminal Epidural Injection of L5.

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Optimal Angle of Needle Insertion for Fluoroscopy-Guided Transforaminal Epidural Injection of L5.

Pain Pract. 2014 Apr 1;

Authors: Ra IH, Min WK

Abstract
BACKGROUND: Unlike other sites, there is difficulty in performing TFESI at the L5-S1 level because the iliac crest is an obstacle to needle placement.
OBJECTIVE: The objective of this study was to identify the optimal angle of fluoroscopy for insertion and advancement of a needle during L5 TEFSI.
METHODS: We conducted an observational study of patients undergoing fluoroscopy-guided L5 TFESI in the prone position. A total of 80 patients (40 men and 40 women) with radiating pain of lower limbs were enrolled. During TFESI, we measured the angle at which the L5 vertebral body forms a rectangular shape and compared men and women. Then, we measured area of safe triangle in tilting angle of fluoroscopy from 15° to 35° and compared men and women.
RESULTS: The mean cephalocaudal angle, where the vertebral body takes the shape of a rectangle, was 11.0° in men and 13.9° in women (P = 0.007). In men, the triangular area was maximal at 18.3 mm² with an oblique view angle of 25°. In women, the area was maximal at 23.6 mm² with an oblique view angle of 30°. At an oblique view angle of 30° and 35°, the area was significantly greater in women (P < 0.05).
CONCLUSION: When TFESI is performed at the L5 region in the prone position, placement of fluoroscopy at a cephalocaudal angle of 11.0° and an oblique angle of 25° in men and cephalocaudal angle of 13.9° and an oblique angle of 30° in women would be most reasonable.

PMID: 24690186 [PubMed – as supplied by publisher]

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