1. Flouro Images of Lumbar Spine Injections
David F. Drake, MD
Director, VCU PM&R Pain Fellowship
David Berkower, MD
Pain Fellow

2. Using Contrast Dye
The following views were obtained using an injection dummy and therefore no contrast dye was used.
We recommend, when available, the use of contract dye to confirm needle placement

3. Lumbar Median Branch Block (MBB)
The flouro is placed
in the oblique position
at approx 30 degrees
to view the “scotty dog”.
The needle is directed at
the eye of the “scotty
dog” and advanced until
bone is contacted.
Needle

4. Lumbar Facet Injection
A lumbar facet injection would be done in a similar fashion as a MBB, however the target is the facet joint (between the ear of the lower “scotty dog” and the front foot of the upper “scotty dog”).

5. Sacroiliac Injection The flouro is placed just off AP in order to
align the inferior poles
of the SIJ. The needle
is advanced into the
inferior poles until a
loss of resistance is
appreciated.
Needle

6. AP View of Lateral Hip Injection
The lateral hip approach avoids the nerves and vessels which may be encountered in the anterior approach. It’s wise to get a lateral flouro view to confirm needle placement.

7. AP View of Anterior Hip Injection
When performing a hip
injection from the anterior,
the artery should be palpated
at all times and gentle
negative pressure (aspiration)
in the syringe is important to
avoid intravascular injection.

8. AP View of Anterior Hip Injection – Part 2
A different view

9. Oblique View of Lumbar Transforaminal Epidural
Place the flouro in the oblique position (approx 30 deg). Focus the needle under the chin of the “scotty dog” [superior aspect of lateral foramen].
Needle

10. Lateral View of Lumbar Transforaminal
Obtain a lateral view to
confirm needle is w/in
the foramen.

11. AP View of Lumbar Transforaminal
Finally, obtain an AP view
To confirm the needle is
Medial enough and w/in the
Epidural space.
*Note: for a selective spinal
nerve injection the needle
should be more lateral and
not w/in the epidural space.

12. Oblique View of Disc Injection
The flouro is placed in the
oblique position [approx
30 deg]. The needle is
advanced into the disc
space. A firm, fibrous
sensation is often felt when
entering the disc.

13. Lateral View of Disc Injection
A lateral flouro view is
obtained to confirm
needle depth.

14. AP View of Disc Injection
An AP view may be obtained to assess how medial the needle is.

15. Oblique Lumbar Sympathetic Block
An oblique flouro view
[approx 30 deg] is obtained.
The needle is directed just
anterior to the L-3 vertebral body.
Needle