Atlas of Image-Guided Spinal Procedures

Section 1: Introduction

1. Introduction: How to Use This Atlas

2. Needle Techniques

3. Fluoroscopic Techniques: Anatomy and Set-Up

4. Ultrasound Techniques and Pearls

5. Optimizing Patient Safety and Positioning

6. Radiation Safety

Section 2: Sacral/Coccygeal

7A Caudal Epidural Steroid Injection--Shallow Angle Approach: Fluoroscopic Guidance

7B Caudal Epidural Spinal Injection--Steep Angle Approach: Fluoroscopic Guidance

7C Caudal Epidural Steroid Injection: Ultrasound Guidance

8A Ganglion Impar Injection: Fluoroscopic Guidance

8B Ganglion Impar Injection: Ultrasound Guidance

9. Sacral Insufficiency Fracture Repair/Sacroplasty: Fluoroscopic Guidance

10A Sacroiliac Intraarticular Joint Injections--Posterior Approach, Inferior Entry: Fluoroscopic Guidance

10B Sacroiliac Intraarticular Joint Injection: Ultrasound Guidance

11. S1 Transforaminal Epidural Steroid Injection

Section 3: Lumbar/Lumbosacral

12. Lumbar Interlaminar Epidural Steroid Injection--Paramedian Approach: Fluoroscopic Guidance

13A Lumbar Transforaminal Epidural Steroid Injection--Supraneural, Traditional Single-Needle Technique: Fluoroscopic Guidance

13B Lumbar Transforaminal Epidural Steroid Injection--Supraneural, Two-Needle Technique: Fluoroscopic Guidance

13C Lumbar Transforaminal Epidural Steroid Injection--Infraneural: Fluoroscopic Guidance

13D Lumbar Transforaminal Epidural Steroid Injection--Needle Localization Diagrams

14. Lumbar Myelography: Fluoroscopic Guidance

15A Lumbar Zygapophysial Joint Intraarticular Joint Injection--Posterior Approach: Fluoroscopic Guidance

15B Lumbar Zygapophysial Joint Nerve (Medial Branch) Injection--Oblique Approach: Fluoroscopic Guidance

15C Lumbar Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy, Posterior Approach: Fluoroscopic Guidance

15D Lumbar Medial Branch Blocks--Midline: Ultrasound Guidance

15E Lumbar Zygapophysial Joint Innervation--Anatomy Diagram and Lesion Zone Diagram

16. Lumbar Sympathetic Block: Fluoroscopic Guidance

17A Lumbar Provocation Discography/Disc Access: Standard Fluoroscopic Techniques

17B L5-S1 Disc Access: Fluoroscopic Guidance

Section 4: Thoracolumbar

18. Thoracolumbular Spinal Cord Stimulation: Fluoroscopic Guidance

19. Vertebral Augmentation (Vertebroplasty/Kyphoplasty), Transpedicular Approach: Fluoroscopic Guidance

Section 5: Thoracic

20. Thoracic Interlaminar Epidural Steroid Injection--Paramedian Approach, Fluoroscopic Guidance

21. Thoracic Transforaminal Epidural Steroid Injection--Infraneural Approach

22A Thoracic Zygapophysial Joint Intraarticular Injection--Posterior Approach: Fluoroscopic Guidance

22B Thoracic Zygapophysial Joint Nerve (Medial Branch) Injection--Posterior Approach: Fluoroscopic Guidance

22C Thoracic Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy--Posterior Approach: Fluoroscopic Guidance

22D Thoracic Zygapophysial Joint Innervation--Anatomy Diagram

23A Intercostal Nerve Injections: Fluoroscopic Guidance

23B Intercostal Nerve Injection--In-Plane Approach: Ultrasound Guidance

24. Thoracic Disc Access: Fluoroscopic Guidance

Section 6: Cervical

25. Cervical Interlaminar Epidural Steroid Injection--Paramedian Approach: Fluoroscopic Guidance

26. Cervical Spinal Cord Stimulation, Fluoroscopic Guidance

27. Cervical Transforaminal Epidural Steroid Injection: Fluoroscopic Guidance

28A Stellate Ganglion Injection: Fluoroscopic Guidance

28B Stellate Ganglion Injection: Ultrasound Guidance

29. Cervical Discography/Disc Access

30A Cervical Zygapophysial Joint Intraarticular Injection--Posterior Approach: Fluoroscopic Guidance

30B Cervical Zygapophysial Joint Intraarticular Injection--Lateral Approach: Fluoroscopic Guidance

30C Cervical Zygapophysial Nerve (Medial Branch) Injection--Lateral Approach: Ultrasound Guidance

30D Cervical Zygapophysial Joint Nerve (Medial Branch) Injection--Lateral Approach: Fluoroscopic Guidance

30E Cervical Zygapophysial Joint Intraarticular Injection--Posterior Approach: Ultrasound Guidance

30F Cervical Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy and Nerve Injection--Posterior Approach: Fluoroscopic Guidance

30G Cervical Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy and Nerve Injection--Posterior Approach: Ultrasound Guidance

30H Cervical Zygapophysial Joint Innervation--Anatomy Diagram and Lesion Zone Diagrams

31. Atlantoaxial Joint Intraarticular Injection: Fluoroscopic Guidance

32. Atlantooccipital Joint Intraarticular Injection: Fluoroscopic Guidance

33. Greater Occipital Nerve Steroid Injection-In Plane Approach: Ultrasound Guidance

Section 7: Additional Image-Guided Procedures for the Spine Care and Pain Specialist: Spine Pain Mimickers

Shoulder Region

34A Shoulder/Glenohumeral Joint Intraarticular Injection--Anterior Approach: Fluoroscopic Guidance

34B Intraarticular Shoulder/Glenohumeral Joint Injection--Posterior Approach: Ultrasound Guidance

34C Shoulder/Subacromial/Subdeltoid Injection--Lateral Approach: Ultrasound Guidance

34D Shoulder/Acromioclavicular Joint Injection--Posterior Approach: Ultrasound Guidance

34E Shoulder/Suprascapular Nerve Injection--Posterior Approach: Ultrasound Guidance

34F Shoulder/Biceps Tendon Sheath Injection--Anterior Approach: Ultrasound Guidance

Hip Region

35A Intra-articular Hip Injection--Anterior Approach: Fluoroscopic Guidance

35B Intra-articular Hip Injection--Lateral Approach: Fluoroscopic Guidance

35C Intraarticular Hip Injection--Anterior Approach: Ultrasound Guidance

35D Greater Trochanteric/Gluteus Medius Injection: Ultrasound Guidance

35E Lateral Femoral Cutaneous Nerve Injection: Ultrasound Guidance

36A Iliac Crest Biopsy/Aspiration: Fluoroscopic Guidance

36B Iliac Crest Biopsy: Ultrasound Guidance

Appendix

Spine Intervention References and Tables