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Correspondence  |   December 2004
Frequent Utilization of Fluoroscopy Is Essential for Precise Needle Placement in Interventional Pain Procedure
Author Affiliations & Notes
  • Kris Vissers, M.D., Ph.D.
    *
  • * Multidisciplinary Pain Center, Genk, Belgium.
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, 1482. doi:
Anesthesiology 12 2004, Vol.101, 1482. doi:
In Reply:—
We thank Dr. Huang for his interesting comments. We agree that frequent control of the correct needle position by the use of fluoroscopy is important during interventional pain procedures.1 
The depth of the needle position on a lateral view is important because antiinflammatory agents must be injected as close as possible to the site of pathology; i.e.  , in the anterior plane of the epidural space.2 With respect to the presented anteroposterior view (Fig. 2a in our article)1 and in accordance with another review,3 the insertion of the needle no further medial than the six o’clock position in the anteroposterior view reduces the risk of dural puncture.3 Moreover, when our needle had been positioned intradurally at this level, a discogram could not have been explained.
Finally, low back pain and sciatica resulting from migrated disc herniations are an indication for transforaminal epidural infiltrations.4 By placing the needle in a correct fluoroscopic position, the needle can accidentally encounter a rostrally displaced disc herniation, which possibly explains this unexpected event. Our finding emphasizes the use of fluoroscopy in interventional pain procedures.
* Multidisciplinary Pain Center, Genk, Belgium.
References
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Derby R, Bogduk N, Kine G: Precision percutaneous blocking procedures for localizing spinal pain: Part 2. The lumbar neuroaxial compartment. Pain Digest 1993; 3:62–75Derby, R Bogduk, N Kine, G
Noor MG: Selective nerve root blocks for low back pain and radiculopathy. Reg Anesth and Pain Med 2004; 29:234–56Noor, MG
Vad VB, Bhat AL, Lutz GE, Cammisa F: Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine 2002; 27:11–6Vad, VB Bhat, AL Lutz, GE Cammisa, F