Novel Method for S1 Transforaminal Epidural Steroid Injection

Area of Science:

• Pain Management
• Interventional Radiology
• Neurology

Background:

• S1 transforaminal epidural steroid injection (S1-TFESI) effectively treats S1 nerve root pain.
• Fluoroscopic guidance is standard but involves radiation exposure.
• Ultrasound guidance has limitations in confirming needle tip position and vascular uptake.

Purpose of the Study:

• To describe a novel technique for S1-TFESI using complementary ultrasound and fluoroscopy.
• To confirm the reproducibility of this new S1-TFESI approach.

Main Methods:

• Retrospective review of patients with S1 radiculopathy undergoing the new S1-TFESI technique.
• Ultrasound guided initial needle entry point identification.
• Fluoroscopy confirmed needle tip position and checked for vascular injection.

Main Results:

• Sixty-seven S1-TFESIs were performed in 56 patients.
• All injections demonstrated epidural spread of contrast.
• The mean number of needle reinsertion attempts was low (1.24 ± 1.25).

Conclusions:

• The novel technique effectively uses ultrasound for initial guidance and fluoroscopy for confirmation.
• This combined approach complements the limitations of using either modality alone.
• The technique is reproducible and enhances S1-TFESI procedures.