Performing thoracic transforaminal injections: a new technique.

Abstract

To evaluate a technique to perform fluoroscopically directed thoracic transforaminal epidural injections. Institutional review board approval and a waiver of consent were obtained for this retrospective HIPAA-compliant study. Findings from 198 consecutively performed foraminal nerve blocks and foraminal epidural injections in the thoracic spine from June 27, 1997 to December 29, 2007 were retrospectively reviewed. This study was designed to evaluate a current technique and the experience with an approach that improves safety by decreasing the chance of inadvertent injury to nontargeted structures. Fluoroscopic spot views retained as part of a quality assurance program were available in all patients for review. By utilizing this technique, there was a single delayed pneumothorax that occurred because of deviation from the accepted technique. No other major complications occurred (which the authors defined as death, neurovascular injury, pneumothorax, and infection). Inadvertent puncture of the dura did not occur. Minor complications included vasovagal response and transient pain during the administration of injectate, which were resolved by the termination of the procedure. The ease of identifying the ribs fluoroscopically and utilizing the rib as a conduit into the foramen provided an advantage in patients with osteopenia, severe osteoarthritis, and scoliosis compared with previously described techniques. This study evaluated an innovative technique to perform fluoroscopically directed thoracic intraforaminal nerve blocks that showed few complications and anatomically avoided transgression of structures in the posterior mediastinum.