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Research ArticleSpine Imaging and Spine Image-Guided Interventions

Inadvertent Intrafacet Injection during Lumbar Interlaminar Epidural Steroid Injection: A Comparison of CT Fluoroscopic and Conventional Fluoroscopic Guidance

P.G. Kranz, A.B. Joshi, L.A. Roy, K.R. Choudhury and T.J. Amrhein
American Journal of Neuroradiology February 2017, 38 (2) 398-402; DOI: https://doi.org/10.3174/ajnr.A5000
P.G. Kranz
aFrom the Departments of Radiology (P.G.K., K.R.C., T.J.A.)
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A.B. Joshi
bOrthopedic Surgery (A.B.J.)
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L.A. Roy
cAnesthesiology (L.A.R.), Duke University Medical Center, Durham, North Carolina.
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K.R. Choudhury
aFrom the Departments of Radiology (P.G.K., K.R.C., T.J.A.)
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T.J. Amrhein
aFrom the Departments of Radiology (P.G.K., K.R.C., T.J.A.)
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    Fig 1.

    Inadvertent intrafacet injection in an 84-year-old woman with back pain who underwent ILESI with CTF. A, Preinjection axial CTF image before needle placement into the ligamentum flavum. B, Initial CTF image obtained after loss of resistance shows contrast in the facet joint ipsilateral to the injection (arrow). Contrast also pools around the needle tip in the retrodural space of Okada and extends into the interspinous bursa (arrowhead). C, The needle was subsequently advanced through the ligamentum flavum. Contrast is now seen in the epidural space (arrow).

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    Fig 2.

    Inadvertent intrafacet injection in a 67-year-old man with spinal stenosis and back pain who underwent ILESI with CTF. A, Preinjection axial CTF image before needle placement into the ligamentum flavum. B, Initial CTF image obtained after loss of resistance shows contrast in the facet joint (white arrow). C, Image obtained after needle advancement shows contrast in the epidural space (arrowhead).

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    Fig 3.

    Inadvertent intrafacet injection in a 63-year-old man with a painful L4–5 central disc protrusion who underwent ILESI by using conventional fluoroscopic guidance. The final procedural image shows a triangular configuration of contrast overlying the inferior aspect of the left L4–5 facet joint, consistent with intrafacet injection.

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American Journal of Neuroradiology: 38 (2)
American Journal of Neuroradiology
Vol. 38, Issue 2
1 Feb 2017
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P.G. Kranz, A.B. Joshi, L.A. Roy, K.R. Choudhury, T.J. Amrhein
Inadvertent Intrafacet Injection during Lumbar Interlaminar Epidural Steroid Injection: A Comparison of CT Fluoroscopic and Conventional Fluoroscopic Guidance
American Journal of Neuroradiology Feb 2017, 38 (2) 398-402; DOI: 10.3174/ajnr.A5000

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Inadvertent Intrafacet Injection during Lumbar Interlaminar Epidural Steroid Injection: A Comparison of CT Fluoroscopic and Conventional Fluoroscopic Guidance
P.G. Kranz, A.B. Joshi, L.A. Roy, K.R. Choudhury, T.J. Amrhein
American Journal of Neuroradiology Feb 2017, 38 (2) 398-402; DOI: 10.3174/ajnr.A5000
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  • Retrodural space of Okada in the posterior ligamentous complex region: clinical and anatomical findings relevant to lumbar interlaminar epidural injection
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