lumbar transforaminal steroid injection for radicular pain: C arm, lecture & clinical case:

C arm guided lumbar transforaminal steroid injection technique:
I explained the C-arm anatomy of the lumbar spine. I choose AP and oblique C arm guidance interventional procedure rather than the oblique and lateral approach. It took more time and radiation hazard to undergo the lateral C arm guided procedure. In this tutorial, you will learn the basic step of an interventional procedure and how to handle the C arm image.
you will learn MRI features of patients who need a transforaminal steroid injection.
this course is an Image training channel. you would recognize in the feature that you advanced much by just repeating playback.
repeated watching will give you more opportunity to understand and you doing practice by yourself.
It is the goal of the image training session.
#heimagetraining #lumbar #backpain #interventionaltreatment #Ziemvision #Carm #transforaminal #facetjoint #chronicpain
#투시 #요통 #통증중재시술 #만성통증 #신경차단술 #이미지트레이닝 #요추후관절통증 #요추신경통 #요추신경근통

[@ziaulhasan9440]

Brilliantly done

[@practicalpainmanagementwit8115]

thank you

[@rajendraraval5367]

Very informative thanks Sir for this teaching vdo

[@practicalpainmanagementwit8115]

So nice of you

[@Deep_root]

Thank you so much sir for sharing knowledge

[@practicalpainmanagementwit8115]

It's my pleasure

[@Painfix_Rx]

Sir Great Work and Very Good Educational Resource For US .Keep Going with more training vedios .It will be better if you share the USG guided Procedures besides this procedure

[@practicalpainmanagementwit8115]

thank you I will keep upload many contents for this year.

[@abdullahbilalmuhammadyaqoo4297]

Thanks alot sir

[@practicalpainmanagementwit8115]

thank you

[@rafaelmoralesvalero4358]

Sir, what do you do if steroid injection or pulse radiophrecuency do not improve the pain in a radicular pain? Thank you very much!

[@practicalpainmanagementwit8115]

surgical treatment will be the final option.

[@joshlee261]

What is the concentration percent of dextrose and ml per injection? Thanks

[@practicalpainmanagementwit8115]

this video is created several years ago, there are many lectures that answer your question

[@mermaidsea2999]

thank you for your video. I appreciate it so much :3 . I have some questions 1. Wich size spinal needle u r using 2. In ICD 9 which code do u use

[@practicalpainmanagementwit8115]

I use a Quinke type of 90mm 25G needle. M47.26 is the most commonly used Current Procedural Terminology (CPT) code for reporting the injection of a needle for diagnostic or therapeutic purposes into a nerve or ganglion

[@mermaidsea2999]

I mean the prodecure code

[@timmy101able]

Will these shots help if the bulging disc is so severe as it seemed in the images??

[@practicalpainmanagementwit8115]

The bulging is the morphologic diagnosis of the spine. Rather you describe the as the discogenic pain or compressive neuropathy or pain in case of central stenosis and foraminal stenosis. With the different viewpoint of the bulging disc, you can make a injection strategy and make a different appraoch

[@yhkim7113]

Thank you so much for good information. Even though it is not for cervical injection, Triamcilnolon which is particulate steroid is relatively less safe than non-particulate steroid such as dexamethasone and so on. Do you have any reason to prefer Triam?

[@practicalpainmanagementwit8115]

sorry for late answer. I always use nonparticulate steroids. lipid form of dexamethasone is stronger than normal dexamethasone. but unfortunatly, there are many contries that can not available.

[@roghaniorthopaedicandpainc5133]

Hello Doc awesome I really love the procedure. But onething why u mix dextrose 15% injected along with LA n steroid . Dextrose as a regeneration ?

[@practicalpainmanagementwit8115]

I use the effect of hypertonicity, not regeneration. If you watch more lectures, you will understand

[@roghaniorthopaedicandpainc5133]

@@practicalpainmanagementwit8115 I myself an orthopedic Surgeon from Peshawar,Pakistan .doing dextrose prolotherapy,ozone intra diskal and pain portal blocks for backache,shoulder etc.

[@ВаняШатунов-л3ю]

we should hit the bone at 6 oclock of pedicle in transforaminal lumbar block?

[@practicalpainmanagementwit8115]

No we do not hit the bone. If you use the contralateral oblique view, you will notice the exact target subpedicular space by combination of AP view and contralateral oblique view.

[@MrTypealpha]

Dr. Lee why dont you use local anesthesia?

[@MrTypealpha]

local anesthesia before poking the skin?

[@practicalpainmanagementwit8115]

because there is no difference between local anesthetic and direct needle insertion. The patient feels pain from local anesthetics also. The patient will be very cooperative if you use a 24 G needle and gentle procedure.

[@DEVINE.IMAGE.]

Is it normal that im in alot more pain 2 days after having steroid injection its alot worse then it fist was

[@practicalpainmanagementwit8115]

the rate of worse after steroid injection is about 10 %. I think it depends on the operator's skill. It is a invasive procedure, sometimes touching nerve root or perineural structuers. also it depends on the patient's pathology.Some patients have neuropathy and very sensitive to needlling procedure.

[@timmy101able]

Thank you I am a doctor in the US just beginning training in lower back pain and your videos are educational

[@practicalpainmanagementwit8115]

thank you

[@toosoo9]

선생님 안녕하세요.. 좋은 영상 감사합니다.. 사용하시는 니들이 spinal 니들 같은데 팁 부분은 켈리로 약간 휘어서 쓰시는 건가요? 아니면 완제품으로 저렇게 나온 게 있는지 궁금합니다.. 아 그리고 마지막 팁 위치 조정을 AP뷰로 하시는데 선생님께서 예전에 다른 영상에서 가르쳐주신 CLO 뷰를 이번 프로시저에선 쓰시지 않은 이유가 있는지 궁금합니다.. 좋은 하루 되세요!!

[@practicalpainmanagementwit8115]

이 동영상은 3년전 동영상이고 CLO는 그 이후 개발된 방법입니다. 겔리로 안하고 그냥 소독 거즈로 하면 됩니다

[@toosoo9]

@@practicalpainmanagementwit8115 아.. 답변 감사드립니다!!

[@victoriagiusto7553]

Hey doc , I would like a rotation shadow in you .

[@practicalpainmanagementwit8115]

thanks

[@blingcling996]

선생님 잘 보고 있습니다. 근데 SNRB랑 차이가 무얼까요?

[@practicalpainmanagementwit8115]

한국에서는 차이 없습니다. 수가 차이만 나는데 transforaminal epidural이 수가가 높지만, 많이 청구하면 삭감을 해댑니다.

[@jdesantiagom]

Thank you Dr.Lee!!! What concentration of dextrose do you usually use? Awesome educational videos.

[@practicalpainmanagementwit8115]

I use 40% dextrose

[@dr.yashsingh1489]

Can we use 25% Dextrose?? And how much to use?? What is your usual volume?

[@marryjatt6758]

I have done this today but I am feeling severe pain in my all over body.even I can not sleep due to ...Anybody would tell me that, this is side effect of injection or not??

[@practicalpainmanagementwit8115]

You have to find a good hand, skillful interventionist. the rate of postinjection sore depends on the technical aspect.

[@Anonymous-fw6ym]

How is ur pain now?

[@marryjatt6758]

@@Anonymous-fw6ym it's better now I have a little pain in my leg whenever I work

[@leehabilitation445]

선배님 안녕하십니까? 로컬에서 통증을 하고있는 재활의학과 전문의입니다. TFEB시, 덱사보다 트리암을 주로 사용하시는지요?

[@practicalpainmanagementwit8115]

dexa는 별로 효과가 없는 것 같습니다.

[@배상욱-c5k]

저도 트리암이 효과가 뛰어나다고 생각되나 약설명서를 보면 경막외주사에는 사용하지말라고 되어있어 덱사로 바꿨는데 글쎄 효과는 트리암만 못하다고 개인적으로 생각합니다.

[@dr.diwaskatwalchhetri]

How will u use contralateral oblique view for carm and angle to be used ! Thank you

[@practicalpainmanagementwit8115]

watch more videos, you will have answers

[@mahmouda4581]

great work but why didn't go for lateral view to confirm proper depth?

[@practicalpainmanagementwit8115]

You can find several more reasons if you watch some more videos. One of the most important factors is the lead shield drape that covers the patient's body to protect me from radiation.

[@jimmyDhamma]

Halo dr. Lee, My Name is Jimmy, Neurologist from Indonesia, I'm very thankful for your video, hopefully you can make regular videos like this. I wanna ask you dr. lee, why do you combine steroid+dextrose? I think that these two have different mechanisms and we can't give them in same time, and How many cc/ml do you mix these? Thank you dr. lee

[@practicalpainmanagementwit8115]

dextrose is not equal to proliferant. Please don't think it is opposite to steroid.

[@jimmyDhamma]

So what is the reason in using dextrose dr. Lee?

[@zilack33]

안녕하세요 선생님 전 22g 8cm 투오니들을 쓰는데 l45는 짧아서 어렵습니다 선생님께서는 어떤니들을 쓰시는지요?

[@practicalpainmanagementwit8115]

안녕하세요. 투오니들은 8cm이고 navigation이 안되어 transforaminal approach는 사용하지 않아요.일반 spinal needle이 좀 더 길어요. 9cm 입니다. 그리고 25G라 환자의 통증도 덜하고 navigation이 더 잘되요. 처음에는 좀 어려울 수 있지만, 익숙하면 이게 훨씬 더 정확하게 사용할수 있어요

[@sebastiancordova270]

¿ What about Lateral view? do you use lateral view to see your needle in the SPQ? after the dye , it looks like selective root nerve block.

[@practicalpainmanagementwit8115]

I rarely use lateral view to confirm the location. I use contralateral oblique view. it is more precise and quick. besides, I can use radiation protective lead draps on contralateral oblique view. I can not use radioprotective drap on lateral view

[@mikhailaveroes1173]

Hi doc. Can we use only perineural3 Dextrose 40% for neuropathic pain? Thx

[@practicalpainmanagementwit8115]

I use steroids, botox, sometimes pulsed radiofrequency

[@zhiktonglim977]

do you feel give way/loss resistance for every patient when you are reach the epidural space?

[@practicalpainmanagementwit8115]

I depend on more contrast spread than the loss of resistance. but also rely on the LOC technique

[@marcelovazperez]

thank you !! Why you don't use dexamethasone, it has more anti-inflammatory proprieties than the others.

[@practicalpainmanagementwit8115]

dexamethasone is potent, but particulate steroids stay longer than dexamethasone in the target.

[@DrSahid-vc6yz]

Thank you sir

[@practicalpainmanagementwit8115]

thank you

[@thegiangnguyen7713]

Cảm ơn bạn!

[@practicalpainmanagementwit8115]

thank you

[@ErikS-]

This is a treatment that is excellently suitable for future robotization. The question is however how to fix the lower back in a position that cannot move. This so the the references for the robot stay the same.

[@practicalpainmanagementwit8115]

thank you

[@Anonymous-fw6ym]

Can we use mix of steroids ?

[@practicalpainmanagementwit8115]

sure