S1 Transforaminal: Technique and Troubleshooting

Abstract

Role of interventions in pain medicine is one of the important aspects. Even if we diagnose the condition correctly but if we are not familiar with the interventions and their troubleshooting we may land up in a problem. Every patient is different; every procedure is a challenge to the pain physician. S1 transfo ra minal is such a procedure which every pain physician should know including its troubleshooting. We must be through with the technical aspects of the interventions .In this article of practitioner's corner, the technique and troubleshooting is being discussed to increase our clinical and intervention accuracy.

Retrospective lumbosacral CT analysis and prospective observational study of the ipsilateral tunnel view technique for fluoroscopy‐guided selective S1 transforaminal epidural injection

“…The possibility of penetrating injury from the viscera ventral to the sacrum during the traditional AP approach was raised by Surange. 5 To avoid the injury, the epidural needle should not be advanced to the floor of the sacral canal, and it should not exit the VS1F in the lateral view. Although the risk of penetrating injury is low, the possibility cannot be completely excluded when using the AP approach in which the entrance of DS1F and VS1F are superimposing.…”

“…The possibility of penetrating injury from the viscera ventral to the sacrum during the traditional AP approach was raised by Surange 5 . To avoid the injury, the epidural needle should not be advanced to the floor of the sacral canal, and it should not exit the VS1F in the lateral view.…”

“…[7][8][9] When performing the S1-TFESI with the trajectory view, the key point is to make the dorsal S1 foramen (DS1F) and ventral S1 foramen (VS1F) to align and superimpose, so they look like a single opening in the standard AP view. However, the DS1Fs are known to be smaller than the VS1Fs, 5 and superimposing these two foramens with different sizes can cause confusion for clinicians to locate the exact entry point in the DS1F. Only few reports have referred to the detailed location of the DS1F during S1 TFESI in the standard AP view, and it is expected to be more difficult to confirm the location of the DS1F in patients with intestinal gas retention, obesity, osteoporosis, or elderly patients.…”

“…TFESIs in the lumbosacral region are most frequently performed through the L5 and S1 transforaminal epidural space. Traditionally, S1-TFESI have been implemented in the anteroposterior (AP) view, 5,6 and some modified methods were also introduced. [7][8][9] When performing the S1-TFESI with the trajectory view, the key point is to make the dorsal S1 foramen (DS1F) and ventral S1 foramen (VS1F) to align and superimpose, so they look like a single opening in the standard AP view.…”

Deep Learning–Based Automatic Segmentation of Lumbosacral Nerves on CT for Spinal Intervention: A Translational Study

“…In practice, spinal intervention and spinal surgery are often recommended for the management of low back pain, and all these procedures heavily rely on medical image guidance. Spinal intervention and spinal surgery at L5/S1 level is problematic due to anatomic obstacles such as high iliac crest, enlarged transverse process, and limited foraminal area [4] [5]. Thus, pre-procedure radiographic evaluation is a key to success, and image-based navigation or robotic procedures may also improve clinical efficiency.…”