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Cadaver Workshop: Lumbar Transforaminal Using a Coudé® Blunt Needle

FATHI AL-KADHI on January 31, 2017 at 12:51 pm
  • Author
      Joined: Aug 27, 2015
      Posts: 1

      Dear Doctor Racz,
      Is there a difference in the technique between lumbar selective nerve block and lumbar transforaminal block?

      • Gabor B RaczGabor B Racz
        Joined: Mar 28, 2016
        Posts: 30

        The answer is Yes. A selective nerve block is a small volume injection. The volume would be .5 to less than 1 ml. A transforaminal injection is where the introduced curved blunt needle is placed in the ventral neural foramen mid canal and a larger volume is documented to go through the foramen into the epidural space and outside. The volume can be tract to open up the ventral epidural space and document exiting the spinal canal. The volumes that we have used many times is 5 ml contrast (Omnipaque) / 5 ml hyaluronidase/ 5 ml local anesthetic and steroid. The difference between the larger volume and smaller volume injection is that the small volume works on radiculopathy, but the larger volume works not only on radiculopathy but back pain also. Remember to do a dural tug before you do the procedure and if you reproduce the patients back pain, the choice of volumes to be used is easy. You can read about dural tug in the InTech publication ” Pain and Treatment” Chapter 10 or in the soon to be available Second Edition of “Techniques of Neurolysis” – Neuroplasty Chapter (Springer).

        Contraindications: Patients with syrinx formation, patients with arachnoiditis, patients with infection, blood thinners or spinal narcotics. Beware of patients with failed back surgery syndrome that may have partial dural tears. If patient has dense scarring a transforaminal (Versa-Kath with 18g RX Coude Needle) may be the answer.

        Primum Non Nocere
        Gabor B. Racz, M.D, FIPP, ABIPP, ABPM
        Past President WIP
        Grover E. Murray Professor

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