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Correspondence  |   December 2004
Frequent Utilization of Fluoroscopy Is Essential for Precise Needle Placement in Interventional Pain Procedure
Author Notes
  • Anesthesiologists of Greater Orlando, Orlando, Florida.
Article Information
Correspondence
Correspondence   |   December 2004
Frequent Utilization of Fluoroscopy Is Essential for Precise Needle Placement in Interventional Pain Procedure
Anesthesiology 12 2004, Vol.101, 1481. doi:
Anesthesiology 12 2004, Vol.101, 1481. doi:
To the Editor:—
I read with interest the article recently published by Haspeslagh et al.  1 concerning an inadvertent lumbar disc injection which occurred during unilateral diagnostic infiltration of lumbar L3 nerve root.
Although the authors did mention the importance of fluoroscopy, they did not extensively discuss the reasons for the complication. This event must have the caused by a failure to note the depth of needle insertion during the procedure. The needle tip on the lateral view should be in the posterior aspect of the foramen when the transforaminal epidural injection is performed.2 The authors’ figure suggests that the needle had been inserted too far; the tip of the needle was beyond the dura, therefore no epidurogram was demonstrated in the fluoroscopic images.
As the authors indicated, “meticulous care should be taken when a transforaminal epidural injection…fsis performed.” In addition, frequent utilization of fluoroscopy in different planes during the needle insertion (not just at the time of dye injection) is essential for precise needle placement.
Anesthesiologists of Greater Orlando, Orlando, Florida.
References
Haspeslagh S, Van Zundert J, Puylaert M, Heylen R, van Kleef M, Vissers K: Unilateral diagnostic infiltration of lumbar L3 nerve root resulting in an inadvertent discogram: the importance of fluoroscopic guidance in interventional pain therapy. Anesthesiology 2004; 100:1019–21Haspeslagh, S Van Zundert, J Puylaert, M Heylen, R van Kleef, M Vissers, K
Raj P, Lou L, Erdine S, Staats P: Decompressive neuroplasty, Radiographic Imaging for Regional Anesthesia and Pain Management, 1st ed. Raj P, Lou L, Erdine S, Staats P, eds. Philadelphia, Churchill Livingstone, 2003, pp 254–71Raj, P Lou, L Erdine, S Staats, P Raj P, Lou L, Erdine S, Staats P Philadelphia Churchill Livingstone