Seated transforaminal injection approach in severe lumbar stenosis

The use of seated positioning for the performance of a fluoroscopically guided transforaminal lumbar epidural injection is presented. An 81 year old gentleman presented with a lumbar radiculopathy with radiographs demonstrating foraminal stenosis arising in the setting of offending disc pathology, multilevel and advanced central canal compromise, and a scoliotic deformity. He was unable to tolerate prone positioning secondary to radicular pain. A seated approach allowed for the patient to remain comfortable, and a satisfactory epidurogram was observed. Comparative images of the L4 transforaminal injection performed in the prone and seated position may be consistent with an increased foraminal cross sectional area in the seated and forward flexed posture.