The Handbook of C-Arm Fluoroscopy-Guided Spinal Injections PDF

Preface

C-arm fluoroscopy-guided spinal injections have been performed widely for diagnosis and management of spine and para-spinal-related pain disorders. So often, residents and pain fellows do not receive formal training in radiography and the related anatomy of the vertebral column. The purposes of this handbook are to (a) illustrate spinal injections in a step-by step fashion, (b) present fluoroscopy imaging and related spinal anatomy, and (c) describe manipulation of C-arm fluoroscopy to get ideal images for spinal injections.

The concept of this book started off as a compilation of notes and lectures that were put together for the educational benefit of our pain fellows as well as those residents who rotate on the pain service. The residents spend 2 months on the service and often have a difficult time orienting themselves to the C-arm and the resulting fluoroscopic images. While there are now quite a few books on the market that show the final needle position for spinal injections, we felt that there was a need for a book describing a more basic, step-by-step approach to spinal injections. As a pain fellow, Dr. Linda Wang started collecting images and teaching tools to help her better understand the reasoning behind the fluoroscopic images that were used for spinal injections. As a faculty member, Dr. Wang spent a tremendous amount of time studying the relationships between the skeletal model, the matching fluoroscopic image, and the desired needle placement in the cervical, lumbar, and sacral spinal regions. There is often a skeleton hanging prominently in the procedure room that is used as a reference when we perform fluoroscopically guided injections. Dr. Wang sought to recreate those images in her chapters that effectively demonstrate the relationships between the angle of the x-ray beam and the spinal column. In the chapters describing the fluoroscopic imaging of the cervical, lumbar, and sacral spine, Dr. Wang describes in detail how the trainee would go about obtaining the views needed to approach the spine at each level. Dr. McKenzie-Brown has long had an interest in the cervical spine and procedures performed around the cervical spine as well as in lumbar discography. The neck houses critical vascular structures that affect the way in which injections around the cervical spine are performed. The chapters that she wrote pertaining to cervical injections show a safe method for performing these injections under fluoroscopy. As our program became more interventional in the management of pain, Dr. McKenzie-Brown became more interested in radiation safety, and the basic tenets of radiation safety are succinctly described in Chapter 3. Finally, the sympathetic chapters are left as a category unto themselves. Until fairly recently, stellate and lumbar sympathetic injections were routinely performed without fluoroscopy. Dr. Wang takes us through step-by-step approaches to each of the sympathetic blocks with insights into how to ascertain the correct needle position at each level. Dr. Wang was encouraged by Dr. Allen H. Hord to enter the area of pain medicine. Dr. Hord served as a motivator and educator in the training of Dr. Wang and countless other physicians in the area of C-arm fluoroscopic techniques. His review of this handbook proved to be an invaluable asset.

Each of the spinal injections in this handbook is simply written. The preferred patient's position as well as C-arm fluoroscopy position, preferred fluoroscopic images, and related anatomic structures on the spine are described. The steps taken to get to the final placement of the needle tip are also described. Not only are the correct needle placements illustrated from different views of the spine, but possible incorrect needle placements are shown as well. We endeavored to provide a handbook that will become a useful teaching aid for residents and fellows striving to improve their skills in the performance of spinal injections for pain management.