Atlas of Image-Guided Spinal Procedures

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IFC
Atlas of Image-Guided Spinal Procedures
Atlas of Image-Guided Spinal Procedures
	Radiation Terms (Used only in Chapter 6)
	Cervical Levels
	Thoracic Levels
	Lumbar Levels
	Sacral Levels
Atlas of Image-Guided Spinal Procedures
Copyright
Dedication
CONTRIBUTORS
REVIEWERS
FOREWORD
PREFACE TO THE FIRST EDITION
	THE EVOLUTION OFIMAGE-GUIDED SPINE CARE
	SETUP IS KEY
PREFACE TO THE SECOND EDITION
	SETUP IS KEY
	THE EVOLUTION OFIMAGE-GUIDED SPINE CARE
ACKNOWLEDGMENTS
EDITOR BIOGRAPHY
CONTENTS
VIDEO CONTENTS
I - Introduction
	1 - Introduction: How to Use This Atlas
		BOOK FORMAT
		FLUOROSCOPIC VIEWS
			?Trajectory View: “Setup Is Key”
			?Trajectory View: “Setup Is Key”
			?Multiplanar Views
			?Safety Considerations
			?Optimal Image (Fig. 1.4)
			?Suboptimal Image (Fig. 1.5)
			Fluoroscopic Angle Icons
				ULTRASOUND VIEWS
					Linear/Curvilinear Transducer Icons
			In-Plane Icons (Linear and Curvilinear)
			Out-of-Plane Icons (Linear and Curvilinear)
		SUMMARY
	2 - Needle Techniques
		NEEDLE ANATOMY
		BEVEL CONTROL
		BENDING THE NEEDLE TIP: ENHANCED STEERABILITY
		NEEDLE GAUGE
		NEEDLE DRIVING
		CONCAVITY (FINGER FULCRUM)
		MEDIAL VERSUS VENTRAL NEEDLE ADVANCEMENT
		“THE MOVE”
		FINGER DEPTH GAUGE
		EXTENSION TUBING
		SUMMARY
		References
	3 - Introduction to Fluoroscopic Techniques: Anatomy, Setup, and Procedural Pearls
		Review of Spine Anatomy (Fig. 3.1)
		C-Arm Equipment (Figs. 3.2 and 3.3)
			Thoracic
			Lumbosacral
			Lumbosacral Transitional Segments/Atypical Segmental Enumeration
			Confirming the Correct Segment: A Technical Note
		Obtaining “True” Anteroposterior Views
			“Treat the Patient, Not the Table”
			Oblique the C-Arm to Optimize the “True” Anteroposterior View
			Tilt the C-Arm to Optimize the “True” Anteroposterior View
		Obtaining “True” Lateral Views
			Oblique the C-Arm to Optimize the “True” Lateral View
			Wig-Wag the C-Arm to Optimize the “True” Lateral View
		Patient in a Side-Lying Position
		Oblique Views
			Foraminal Oblique (Cervical Spine) View
			The “Scotty Dog” in Lumbar Oblique Projections
			Contralateral Oblique View to Visualize the Ventral Aspect of the Lamina
		Contralateral Oblique View Versus Lateral View
		Optimizing Needle Trajectory
			Parallax
			Magnification
			“Tuning” an Oblique View for Optimal Needle Trajectory
		Differentiating Superimposed Superficicial vs. Deep or Bilateral Structures
		Additional Procedural Pearls
			Optimizing the Working Environment
			Bilateral and Multilevel Procedures
			Improving Image Quality
			Superimposed Needle Separation
			Needle Displacement to Identify the Needle of Interest
			“Live” Contrast Flow and Digital Subtraction Imaging
		References
	4 - Ultrasound Techniques and Procedural Pearls
		Introduction
		ULTRASOUND EQUIPMENT
			Base Unit (Fig. 4.1)
			Transducers
				Linear (Fig. 4.2)
				Curvilinear (Fig. 4.3)
				Hockey Stick (Fig. 4.4)
		KNOBOLOGY
			Image/Video Loop Capture
			Freeze
			Depth/ Frequency (Fig. 4.5A, B)
			Caliper
			Gain (Fig. 4.6A, B)
			Color Doppler/Power Doppler (Fig. 4.7A, B)
			Zoom (Fig. 4.8A, B)
			Focal Zones (Fig. 4.8C, D)
			Needle Enhancement/M-Line Needle Enhancement (Fig. 4.9A)
			M-line (Fig. 4.9B, C)
			Extended Field of View (Fig. 4.9D)
		ULTRASOUND ERGONOMICS
			Optimal Setup (Fig. 4.10)
			Transducer Grip
				Optimal
				Suboptimal (Fig. 4.13)
		ULTRASOUND TRANSDUCER MOVEMENTS
			Tilt (Toggle) (Fig. 4.14)
			Translation (Fig. 4.15)
			Rotation (Fig. 4.16)
			Heel-Toe/Rocking (Fig. 4.17)
			Adjustment of Transducer Pressure (Fig. 4.18A, B)
			Sonopalpation (Fig. 4.19)
		DEFINITIONS OF VIEWS/APPROACHES
			Axes
				Long Axis (Fig. 4.20A)
				Short Axis (Fig. 4.20B)
		PLANES
			In-Plane (Fig. 4.21A, B)
			In-Plane Needle Optimization
			Out-of-Plane (Fig. 4.22A, B)
		ADDITIONAL TIPS AND TRICKS
			Gel Buildup/Standoff (Fig. 4.23A, B)
			Triangulating for Depth
			“Walk-Down” Technique (Fig. 4.24)
			Scanning Technique Utilizing Needle Bend (Fig. 4.25)
			Hydrodissection (Fig. 4.26A, B)
			Shaken/Turbulent Injectate for Air Contrast (Fig. 4.27A, B)
		CERVICAL SONOANATOMY (FIGURES 4.28 TO 4.32)
			Method 1: Coronal View—Counting Cervical Vertebrae
			Method 2: Axial View—Identifying the C6 Vertebrae via Chassaignac’s Tubercle (Prominent Anterior Tubercle of the C6 Transverse P...
			Method 3: Axial View—Determining Level by Identifying the T1 Transverse Process vs. the C7 Transverse Process
		LUMBOSACRAL SONOGRAPHY
			Axial Evaluation
	5 - Optimizing Patient Safety and Positioning
		INTRODUCTION
		PREPROCEDURE
		INTRAPROCEDURAL SAFETY
			Marking the Correct Procedure Side (Fig. 5.1)
			Procedure Time-Out/Proper Site Board (Fig. 5.2)
			Use of the C-Arm (Fig. 5.3)
			Monitoring Vital Signs
			Supplemental O2 via Nasal Cannula
			Monitoring Cases During Intravenous Sedation
		PATIENT COMFORT
			Squeeze Ball (Fig. 5.4)
		PATIENT POSITIONING
			Prone
			Side-Lying/Lateral
			Supine
		MANAGING INFECTION RISK
			Steps to Ensure Proper Sterilization
			Sterilization Agents Used
			Ultrasound-Guided Procedures
			Tray Setup and Handling of Needles
			X-Ray Pedal
		References
		Suggested Readings
	6 - Radiation Safety
		BACKGROUND
		PROPER C-ARM OPERATION: LIMITING EXPOSURE TIME
		PROPER C-ARM OPERATION: MAXIMIZING DISTANCE
		PROPER C-ARM OPERATION: SHIELDING
		OTHER USEFUL TECHNIQUES TO LIMIT RADIATION EXPOSURE
		RADIATION EXPOSURE MONITORING
			Monitoring Interventionalists and Staff Radiation Exposure
			Monitoring Patient Radiation Exposure
			Quantifying Patient Radiation Exposure: A “Real-World” Perspective
			Suggested Readings
II - Sacral/Coccygeal
	7 - Caudal Epidural Steroid Injection
	7A - Caudal Epidural Steroid Injection—Shallow Angle Approach: Fluoroscopic Guidance
		?Trajectory View (Fig. 7A.1)
		PALPATION
		?Optimal Needle Position in Multiplanar Imaging (Fig. 7A.2)
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW
		OPTIMAL NEEDLE POSITIONING IN THE ANTEROPOSTERIOR VIEW (FIG. 7A.3)
		?Optimal Image (Fig. 7A.4)
		CAUDAL EPIDURAL STEROID INJECTION WITH A CATHETER (FIGS. 7A.5 AND 7A.6)
		?Suboptimal Needle Placement and Images (Figs. 7A.7 to 7A.9)
	7B - Caudal Epidural Steroid Injection—Steep Angle Approach: Fluoroscopic Guidance
		?The Trajectory View Is Also a Multiplanar View
		?Optimal Needle Positioning in Multiplanar Imaging (Fig. 7B.2)
		?Optimal Images (Fig. 7B.3)
		?Suboptimal Needle Placement and Images
		References
	7C - Caudal Epidural Steroid Injection: Ultrasound Guidance
		?In-Plane Technique (Fig. 7C.1)
		?Out-of-Plane Confirmation (Fig. 7C.2)
		?Optimal Images
		?Suboptimal Image (Fig. 7C.3)
	8 - Ganglion Impar Injection
	8A - Ganglion Impar Injection: Fluoroscopic Guidance
		LATERAL VIEW (FIG. 8A.2)
		?Optimal Images (Fig. 8A.3)
			LATERAL VIEW
			ANTEROPOSTERIOR VIEW
		?Suboptimal Images (Figs. 8A.4 to 8A.9)
		SUPPLEMENTAL APPROACHES AND ILLUSTRATIONS
		Reference
	8B - Ganglion Impar Injection: Ultrasound Guidance
		?Out-of-Plane Technique
		?Multiplanar View
		?Optimal and Suboptimal Images
		References
	9 - Sacral Insufficiency Fracture Repair/Sacroplasty
		?Trajectory View
			OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 9.2)
			OPTIMAL NEEDLE POSITIONING IN THE ANTEROPOSTERIOR VIEW (FIG. 9.3)
		?Optimal Cement Patterns
		?Suboptimal Cement Patterns
			References
			Suggested Reading
	10 - Sacroiliac Intraarticular Joint Injection
		References
	10A - Sacroiliac Intraarticular Joint Injection—Posterior Approach, Inferior Entry: Fluoroscopic Guidance
		?Trajectory View
		?The Trajectory View Is Also a Multiplanar View
		?Optimal Needle Position in Multiplanar Imaging (Figs. 10A.2 and 10A.3)
		?The Trajectory View Is Also a Multiplanar View
			OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 10A.4)
			AXIAL MAGNETIC RESONANCE IMAGING OF THE SIJ
		?Optimal Images (Figs. 10A.6, 10A.7,and 10A.8)
		?Suboptimal Images (Figs. 10A.9,10A.10, and 10A.11)
	10B - Sacroiliac Intraarticular Joint Injection:: Ultrasound Guidance
		?In-Plane Technique (Fig. 10B.1)
		?Optimal Image (Fig. 10B.2)
	11 - S1 Transforaminal Epidural Steroid Injection
		?Trajectory View
			OPTIMAL NEEDLE POSITIONING FOR THE ANTEROPOSTERIOR VIEW (FIG. 11.2)
			OPTIMAL NEEDLE POSITIONING FOR THE LATERAL VIEW (FIG. 11.3)
		?Optimal Images (Figs. 11.4, 11.5, and 11.6)
		?OPTIMAL IMAGE
		?Suboptimal Images (Figs. 11.7 and 11.8)
		References
		Suggested Reading
III - Lumbar/Lumbosacral
	12 - Lumbar Interlaminar Epidural Steroid Injection: Paramedian Approach
		?Trajectory View
		?Optimal Needle Position in Multiplanar Imaging
			Optimal Needle Positioning in the Anteroposterior View (Fig. 12.2)
		OPTIMAL NEEDLE POSITION IN THE CONTRALATERAL OBLIQUE VIEW (FIG. 12.3)
		?Optimal Needle Position in the Lateral View (Fig. 12.4)
		?Optimal Images (Figs. 12.5 to 12.6)
		?Suboptimal Images (Figs. 12.7 to 12.9)
		Suggested Readings
	13 - Lumbar Transforaminal Epidural Steroid Injection
		References
	13A - Lumbar Transforaminal Epidural Steroid Injection—Supraneural (Traditional) Approach:: Fluoroscopic Guidance
		?Trajectory View
		?Optimal Needle Position in Multiplanar Imaging
		OPTIMAL NEEDLE POSITIONING IN THE ANTEROPOSTERIOR VIEW
		?Optimal Needle Positioning in the Lateral View
		?Optimal Images
		?Suboptimal Images
		Reference
	13B - Lumbar Transforaminal Epidural Steroid Injection—Supraneural, Two-Needle Technique: Fluoroscopic Guidance
		Phase 1: Introducer Needle Placement
		?Trajectory View
		?Optimal Needle Position in Multiplanar Imaging (Introducer Needle Placement)
			OPTIMAL NEEDLE POSITIONING IN THE ANTEROPOSTERIOR VIEW (INTRODUCER NEEDLE PLACEMENT)
			OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (INTRODUCER NEEDLE PLACEMENT)
		Phase 2: Injection Needle Placement
		Optimal Needle Position in Multiplanar Imaging (Injection Needle Placement)
		?Optimal Needle Positioning in the Anteroposterior View (InjectionNeedle Placement)
		?Optimal Needle Positioning in the Lateral View (Injection Needle Placement)
		Optimal Images (Figs. 13.6 to 13.8)
	13C - Lumbar Transforaminal Epidural Steroid Injection—Infraneural Approach: Fluoroscopic Guidance
		INFRANEURAL APPROACH
		?Trajectory View
		?Optimal Needle Positioning for Multiplanar Imaging
		OPTIMAL NEEDLE POSITIONING FOR THE ANTEROPOSTERIOR VIEW (FIG. 13C.2)
		OPTIMAL NEEDLE POSITION FOR THE LATERAL VIEW (FIG. 13C.3)
		?Optimal Images (Figs. 13C.4 to 13C.8)
		?Suboptimal Images (Fig. 13C.9 and 13C.10)
			?OPTIMAL IMAGE
		?Suboptimal Images (Fig. 13C.9 and 13C.10)
		Suggested Readings
	13D - Lumbar Transforaminal Epidural Steroid Injection: Needle Localization Diagram
	14 - Lumbar Myelography
		?Trajectory View: The Trajectory/Anteroposterior View Is Also a Multiplanar View
			OPTIMAL NEEDLE POSITION IN CONTRALATERAL OBLIQUE VIEW (FIG. 14.2)
			OPTIMAL NEEDLE POSITION IN LATERAL VIEW (FIG. 14.3)
		?Optimal Images (Figs. 14.4 to 14.9)
		?Suboptimal Contrast Patterns (Figs. 14.10 and 14.11)
		Reference
		Suggested Readings
	15 - Lumbar Zygapophysial (Facet) Joint Procedures
		References
	15A - Lumbar Zygapophysial Intraarticular Joint Injection—Posterior Approach: Fluoroscopic Guidance
		?Trajectory View
		?Optimal Needle Position in Multiplanar Imaging
			OPTIMAL NEEDLE POSITIONING IN THE ANTEROPOSTERIOR VIEW (FIG. 15A.4)
			OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 15A.5)
		?Optimal Image
		Additional Views (Figs. 15A.11 and 15A.12)
		Alternative Technique for the Caudad Lumbar Zygapophysial Joints (Fig. 15A.13)
			References
	15B - Lumbar Zygapophysial Joint Nerve (Medial Branch) Injection—Oblique Approach: Fluoroscopic Guidance
		?Trajectory View
		?Trajectory View (Ipsilateral Oblique) Is Also a Multiplanar View (Fig. 15B.1)
		?Optimal Needle Position in Multiplanar Imaging
			OPTIMAL NEEDLE POSITIONING IN THE ANTEROPOSTERIOR VIEW (FIG. 15B.2)
			OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 15B.3)
		?Optimal Images (Fig. 15B.4)
		?Suboptimal Images (Figs. 15B.5 and 15B.6)
	15C - Lumbar Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy—Posterior Approach: Fluoroscopic Guidance
		?Trajectory View
			OPTIMAL NEEDLE POSITIONING IN THE IPSILATERAL OBLIQUE VIEW (FIG. 15C.2)
			OPTIMAL NEEDLE POSITIONING IN THE ANTEROPOSTERIOR VIEW (FIG. 15C.3)
			OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 15C.4)
		?Optimal Position View (Fig. 15C.5)
		?Suboptimal Position Views (Figs. 15C.6 and 15C.7)
		References
	15D - Lumbar Medial Branch Blocks—Midline: Ultrasound Guidance
		?In-Plane Technique (Fig. 15D.1)
		?Out-of-Plane Confirmation (Fig. 15D.2)
		Reference
	15E - Lumbar Zygapophysial Joint Innervation, Anatomy, Dissections, and Lesion Zone Diagrams
	16 - Lumbar Sympathetic Block
		?Trajectory View
		?Optimal Needle Position in Multiplanar Imaging
			Optimal Needle Positioning in the Anteroposterior View (Fig. 16.2)
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 16.3)
		?Optimal Image
		?Suboptimal Images (Figs. 16.6 and 16.7)
		Suggested Readings
	17 - Lumbar Provocation Discography/Disc Access
		References
	17A - Lumbar Provocation Discography/Disc Access: Standard Fluoroscopic Techniques
		?Trajectory View
		?Optimal Needle Position in Multiplanar Imaging
			Optimal Needle Positioning in the Anteroposterior View (Fig. 17A.2)
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 17A.3)
		?Optimal Contrast Images (Figs. 17A.4 to 17A.8)
		?Optimal Image
		?Suboptimal Images (Figs. 17A.9 and 17.10)
		ADDITIONAL INFORMATION
		References
	17B - L5-S1 Disc Access
		DIRECT TRAJECTORY TECHNIQUE
		?Trajectory View
		THE “OVER-TILT”
		THE “CURVED” NEEDLE TECHNIQUE
		?Optimal Needle Position in Multiplanar Imaging
		OPTIMAL NEEDLE POSITIONING IN THE ANTEROPOSTERIOR VIEW (FIG. 17B.5)
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 17B.6)
		?Optimal Images
		ADDITIONAL FIGURES (FIG. 17B.7)
		?Suboptimal Images
		Reference
IV - Thoracolumbar
	18 - Thoracolumbar Spinal Cord Stimulation
		?Trajectory View (Fig. 18.1)
		?Optimal Needle Position in Multiplanar Imaging
		?Needle Positioning in the Contralateral Oblique View (Fig. 18.3)
		?Needle Positioning in the Anteroposterior View (Fig. 18.4)
		?Needle Positioning in the Lateral View (Fig. 18.5)
		?Optimal Spinal Cord Stimulator Positioning (Figs. 18.6 and 18.7)
		?Suboptimal Position Views (Figs. 18.8 to 18.11)
		Alternate Retrograde Spinal Cord Stimulator Placement (Fig. 18.12)
		Reference
	19 - Vertebral Augmentation (Vertebroplasty/Kyphoplasty): Transpedicular Approach
		?Transpedicular Advancement: Trajectory View (Fig. 19.1)
		?Multiplanar Views During Transpedicular Advancement (Figs. 19.2 and 19.3)
		LATERAL VIEW
		?Multiplanar Views During Vertebral Body Advancement
		ANTEROPOSTERIOR VIEW, VERTEBRAL BODY ADVANCEMENT (FIG. 19.4)
		LATERAL VIEW, VERTEBRAL BODY ADVANCEMENT (FIG. 19.5)
		?Multiplanar Views During the Injection of Bone Cement
		SAFETY CONCERNS WITH CEMENT INJECTION
		ANTEROPOSTERIOR VIEW, BONE CEMENT INJECTION (FIG. 19.6)
		LATERAL VIEW, BONE CEMENT INJECTION (FIG. 19.7)
		?Optimal Cement Patterns (Fig. 19.8)
		?Suboptimal Cement Patterns (Fig. 19.9)
		OPTIMAL KYPHOPLASTY INTRODUCER TIP POSITIONS (FIG. 19.10)
		KYPHOPLASTY TECHNIQUE PEARLS
		References
V - Thoracic
	20 - Thoracic Interlaminar Epidural Steroid Injection:: Paramedian Approach
		?Trajectory View (Fig. 20.1)
		?Optimal Needle Position in Multiplanar Imaging
		OPTIMAL NEEDLE POSITIONING IN THE ANTEROPOSTERIOR VIEW (FIG. 20.2)
		OPTIMAL NEEDLE POSITIONING IN THE CONTRALATERAL OBLIQUE VIEW (FIG. 20.3)
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 20.4)
		?Optimal Imaging (Figs. 20.5 to 20.7)
		Suggested Readings
	21 - Thoracic Transforaminal Epidural Steroid Injection: Infraneural Approach
		?Trajectory View
		?Optimal Needle Position in Multiplanar Imaging
		OPTIMAL NEEDLE POSITIONING IN THE ANTEROPOSTERIOR VIEW (FIG. 21.2)
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 21.3)
		?Optimal Images (Fig. 21.4)
		Suggested Reading
	22 - Thoracic Zygapophysial (Facet) Joint Procedures
	22A - Thoracic Zygapophysial Joint Intraarticular Injection—Posterior Approach: Fluoroscopic Guidance
		?Trajectory View
		?Optimal Needle Position in Multiplanar Imaging
		OPTIMAL NEEDLE POSITIONING IN THE AP VIEW (FIG. 22A.1)
		OPTIMAL NEEDLE POSITIONING IN THE CONTRALATERAL OBLIQUE VIEW (FIG. 22A.2)
		?Optimal Images (Figs. 22A.3 and 22A.4)
		Suggested Readings
	22B - Thoracic Zygapophysial Joint Nerve (Medial Branch) Injection—Posterior Approach:: Fluoroscopic Guidance
		?Trajectory View (Fig. 22B.1)
		?Optimal Needle Position in Multiplanar Imaging
		?The Trajectory View (AP) Is Also a Multiplanar View
		?Optimal Needle Position in Multiplanar Imaging
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 22B.2)
		?Optimal Images (Figs. 22B.3 and 22B.4)
		?Optimal Images
		AP
		LATERAL
		Suggested Readings
	22C - Thoracic Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy—Posterior Approach: Fluoroscopic Guidance
		?Trajectory View (Fig. 22C.1)
		?Optimal Needle Position in Multiplanar Imaging
			Optimal Needle Positioning in the Anteroposterior View (Fig. 22C.2)
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 22C.3)
		?Optimal Images (See multiplanar Figs. 22C.2A and 22C.3A)
		?Optimal Imaging
			Anteroposterior View
			Lateral View
		References
		Suggested Readings
	22D - Thoracic Zygapophysial Joint Innervation: Anatomy Diagrams
	23 - Intercostal Nerve Injections
		References
	23A - Intercostal Blockade: Fluoroscopic Guidance
		?Trajectory View (Fig. 23A.1)
		?Optimal Needle Position in Multiplanar Imaging
		OPTIMAL NEEDLE POSITIONING IN THE ANTEROPOSTERIOR VIEW (FIG. 23A.2)
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 23A.3)
		?Optimal and Suboptimal Images (Fig. 23A.4)
	23B - Intercostal Nerve Injection, In-Plane Approach, Ultrasound Guidance
		In-Plane Technique (Fig. 23B.1)
		?Multiplanar View
		?Suboptimal Needle Placement and Images (Fig. 23B.2)
		References
	24 - Thoracic Disc Access
		?Trajectory View (Fig. 24.1)
		?Optimal Needle Position in Multiplanar Imaging
		OPTIMAL NEEDLE POSITIONING IN THE ANTEROPOSTERIOR VIEW (FIG. 24.2)
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 24.3)
		?Optimal Images (Fig. 24.4)
		Suggested Readings
VI - Cervical
	25 - Cervical Interlaminar Epidural Steroid Injection—Paramedian Approach
		?Trajectory View (Fig. 25.1)
		?Optimal Needle Position in Multiplanar Imaging
		OPTIMAL NEEDLE POSITIONING IN THE AP VIEW (FIG. 25.2)
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL SAFETY VIEW
		?Optimal Images (Fig. 25.5)
		?Suboptimal Images (Figs. 25.6 to 25.8)
		References
		Suggested Readings
	26 - Cervical Spinal Cord Stimulation
		?Trajectory View (Fig. 26.1)
		?Optimal Needle Position in Multiplanar Imaging
		NEEDLE POSITIONING IN THE CONTRALATERAL OBLIQUE VIEW (FIG. 26.2)
		NEEDLE POSITIONING IN THE ANTEROPOSTERIOR VIEW (FIG. 26.3)
		NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 26.4)
		?Optimal Images
		Suggested Readings
	27 - Cervical Transforaminal Epidural Steroid Injection
		?Trajectory View (Fig. 27.1)
		?The Trajectory View (Foraminal Oblique) Is Also a Multiplanar View
		?Optimal Views in Multiplanar Imaging
		OPTIMAL NEEDLE POSITIONING IN THE POSTEROANTERIOR VIEW (FIG. 27.2)
		NEURAL VERSUS VASCULAR SAFETY: A TRADE-OFF
		HOURGLASS CONCEPT (FIG. 27.3)
		?Optimal Views (Figs. 27.4 to 27.6)
		?Suboptimal Views (Figs. 27.7 to 27.9)
		Suggested Readings
	28 - Stellate Ganglion Injection
		References
	28A - Stellate Ganglion Block: Fluoroscopic Guidance
		?Trajectory View (Fig. 28A.1)
		?Optimal Views in Multiplanar Imaging
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 28A.3)
		?Optimal Views (Figs. 28A.4 and 28A.5)
	28B - Stellate Ganglion Injection: Ultrasound Guidance
		?In-Plane Technique
		?Out-of-Plane Confirmation
		?Suboptimal Image
	29 - Cervical Discography/Disc Access
		?Trajectory View (Fig. 29.1)
		?Optimal Needle Position in Multiplanar Imaging
		OPTIMAL NEEDLE POSITIONING IN THE POSTEROANTERIOR VIEW (FIG. 29.2)
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 29.3)
		OPTIMAL NEEDLE POSITIONING IN THE CONTRALATERAL OBLIQUE VIEW (FIG. 29.4)
		?Optimal Images (Figs. 29.5 to 29.7)
		?Optimal Image
		Additional Information
		ANTIBIOTICS
		?Suboptimal Imaging (Figs. 29.8 and 29.9)
		References
	30 - Cervical Zygapophysial Joint and Medial Branch Nerve Injections and Radiofrequency Neurotomy
		References
	30A - Cervical Zygapophysial Joint Intraarticular Injection, Posterior Approach: Fluoroscopic Guidance
		?Trajectory View (Fig. 30A.1)
		?The Trajectory View (AP) Is Also a Multiplanar View
		?Optimal Needle Position in Multiplanar Imaging
		?The Trajectory View (AP) Is Alsoa Multiplanar View
		OPTIMAL NEEDLE POSITIONING IN THE CONTRALATERAL OBLIQUE VIEW (FIG. 30A.3)
		?Optimal Images (Figs. 30A.4 to 30A.6)
		References
		Suggested Readings
	30B - Cervical Zygapophysial Joint Intraarticular Injection, Lateral Approach: Fluoroscopic Guidance
		?Trajectory View (Fig. 30B.1)
		?The Trajectory View (Lateral) Is Also a Multiplanar View
		?Optimal Needle Position in Multiplanar Imaging
		?The Trajectory View (Lateral) Is Also a Multiplanar View
		OPTIMAL NEEDLE POSITIONING IN THE ANTEROPOSTERIOR (PILLAR) VIEW (FIG. 30B.2)
		OPTIMAL NEEDLE POSITIONING IN THE IPSILATERAL FORAMINAL OBLIQUE VIEW (TO VISUALIZE THE FORAMINA VENTRAL TO THE Z-JOINTS) (FIG. 3...
		?Optimal Image (Fig. 30B.4)
		?Suboptimal Image (Fig. 30B.5)
		References
	30C - Cervical Zygapophysial Joint Nerve (Medial Branch) Injection—Anterolateral Approach: Ultrasound Guidance
		?Out-of-Plane Technique (Fig. 30C.1)
		?In-Plane Confirmation (Fig. 30C.2)
		?Optimal Needle Placement and Image (Fig. 30C.3)
		References
		Suggested Readings
	30D - Cervical Zygapophysial Joint Nerve (Medial Branch) Injection—Lateral Approach: Fluoroscopic Guidance
		?Trajectory View (Fig. 30D.1)
		?The Trajectory View (Lateral) Is Also a Multiplanar View
		?Optimal Needle Position in Multiplanar Imaging
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW
		OPTIMAL NEEDLE POSITIONING IN THE IPSILATERAL FORAMINAL OBLIQUE VIEW (FIG. 30D.3)
		?Optimal Images (Figs. 30D.4 to 30D.7)
		?Optimal Image
		?Suboptimal Images (Figs. 30D.8 to 30D.9)
		References
	30E - Cervical Zygapophysial Intraarticular Injection—Posterior Approach: Ultrasound Guidance
		?In-Plane Technique (Fig. 30E.1)
		?Out-of-Plane Confirmation (Fig. 30E.2)
		?Optimal Needle Placement and Image (Fig. 30E.3)
		References
		Suggested Readings
	30F - Cervical Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy and Nerve Injection, Posterior Approach: Fluoroscopic Guidance
		?Third Occipital Nerve Trajectory View (Fig. 30F.1)
		?C3, C4, C5, and/or C6 Medial Branch Trajectory View (Fig. 30F.2)
		?C7 Medial Branch Trajectory View (Fig. 30F.3)
		?C8 Medial Branch Trajectory View (Fig. 30F.4)
		?Optimal Electrode Position inMultiplanar Imaging
		OPTIMAL ELECTRODE POSITIONING IN THE ANTEROPOSTERIOR VIEW (FIG. 30F.5)
		OPTIMAL ELECTRODE POSITIONING IN THE LATERAL VIEW (FIG. 30F.6)
		OPTIMAL ELECTRODE POSITIONING IN THE CONTRALATERAL OBLIQUE (FORAMINAL OBLIQUE) VIEW (FIG. 30F.7)
		?Optimal Position Views (Figs. 30F.8 and 30F.9)
		References
	30G - Cervical Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy/Injection—Posterior Approach: Ultrasound Guidance
		?In-Plane Technique (Fig. 30G.1)
		?Out-of-Plane Confirmation (Fig. 30G.2)
		?Optimal Needle Placement and Images
		?Suboptimal Needle Placement and Images (Figs. 30G.3 and 30G.4)
		References
		Suggested Readings
	30H - Cervical Zygapophysial Joint Innervation: Anatomy, Dissections, and Lesion Zone Diagrams
		References
	31 - Atlantoaxial Joint Intraarticular Injection
		?Trajectory View (Fig. 31.1)
		?The Trajectory View (Anteroposterior) Is Also a Multiplanar View
		?Optimal Needle Position in Multiplanar Imaging
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 31.2)
		?Suboptimal Images (Fig. 31.6)
		References
	32 - Atlantooccipital Joint Intraarticular Injection
		?Trajectory View (Fig. 32.1)
		?Optimal Needle Position in Multiplanar Imaging
		OPTIMAL NEEDLE POSITIONING IN THE CONTRALATERAL OBLIQUE VIEW (FIG. 32.2)
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 32.3)
		OPTIMAL NEEDLE POSITIONING IN THE ANTEROPOSTERIOR VIEW (FIG. 32.4)
		?Optimal Image (Figs. 32.5 and 32.6)
		?Suboptimal Image
		References
	33 - Greater Occipital Nerve Steroid Injection—In-Plane Approach
		Introduction
		?In-Plane Technique
		?Optimal Image (Fig. 33.2)
VII - Additional Image-Guided Proceduresfor the Spine Care and Pain Specialist: Spine Pain Masqueraders Shoulder Region
	34 - Shoulder Region Injections
	34A - Intraarticular Shoulder Injections—Anterior Approach: Fluoroscopic Guidance
		?Trajectory View (Fig. 34A.1)
		?The Trajectory View Is Also a Multiplanar View
		?Optimal Needle Position in Multiplanar Imaging (Fig. 34A.2)
		?The Trajectory View Is Also a Multiplanar View
		?Optimal Images (Fig. 34A.3, 34A.4)
		?Suboptimal Image (Fig. 34A.5)
		Reference
	34B - Intraarticular Shoulder Injection—Posterior Approach: Ultrasound Guidance
		?In-Plane Technique (Fig. 34B.1)
		?Out-of-Plane Confirmation (Fig. 34B.2)
		?Optimal Images (Fig. 34B.3, 34B.4)
		?Suboptimal Image (Fig. 34B.5)
	34C - Shoulder/Subacromial–Subdeltoid Bursa Injection—Lateral Approach: Ultrasound Guidance
		?In-Plane Technique (Fig. 34C.1)
		?Out-of-Plane Confirmation (Fig. 34C.2)
		?Optimal Images (Fig. 34C.3)
	34D - Shoulder/Acromioclavicular Joint Injection—Out-of-Plane Approach: Ultrasound Guidance
		?Out-of-Plane Technique (Fig. 34D.1)
		?In-Plane Confirmation (Fig. 34D.2)
		?Optimal Images (Fig. 34D.3)
	34E - Suprascapular Nerve Injection—In-Plane Approach: Ultrasound Guidance
		?In-Plane Technique (Fig. 34E.1)
		?Out-of-Plane Confirmation (Fig. 34E.2)
		?Optimal Images (Fig. 34E.3A to C)
		?Suboptimal Images (Fig. 34E.4A,B)
		Suggested Readings
	34F - Biceps Tendon Sheath Injection—In-Plane Approach: Ultrasound Guidance
		?In-Plane Technique (Fig. 34F.1)
		?Out-of-Plane Confirmation (Fig. 34F.2)
		?Optimal Images (Fig. 34F.3A,B)
		?Suboptimal Images (Fig. 34F.4 andFig. 34F.5)
		Suggested Readings
VII - Additional Image-Guided Proceduresfor the Spine Care and Pain Specialist: Spine Pain Masqueraders Hip Region
	35 - Hip Region Injections
		Suggested Readings
		References
	35A - Intraarticular Hip Injection—Anterior Approach: Fluoroscopic Guidance
		?Trajectory View (Fig. 35A.1)
		?The Trajectory View Is Also a Multiplanar View
		?Optimal Needle Position in Multiplanar Imaging (Fig. 35A.2)
		?Optimal Images (Fig. 35A.4)
		?Suboptimal Images (Figs. 35A.5 and 35A.6)
	35B - Intraarticular Hip Injection—Lateral Approach: Fluoroscopic Guidance
		?Trajectory View (Fig. 35B.1)
		?The Trajectory View Is Also a Multiplanar View
		?Optimal Needle Position in Multiplanar Imaging (Fig. 35B.2)
		?Optimal Images (Figs. 35B.3 and 35B.4)
	35C - Intraarticular Hip Injection—Anterior Approach: Ultrasound Guidance
		?In-Plane Technique (Fig. 35C.1)
		?Out-of-Plane Confirmation (Fig. 35C.2A,B)
		Optimal Image (Fig. 35C.3)
		Suboptimal Images (Fig. 35C.4)
		Suggested Readings
	35D - Greater Trochanteric Bursa/Gluteus Medius Injection: Ultrasound Guidance
		In-Plane Technique (Fig. 35D.1)
		Out-of-Plane Confirmation (Fig. 35D.2)
		Optimal Image (Fig. 35D.3)
		Suggested Readings
	35E - Lateral Femoral Cutaneous Nerve Injection: Ultrasound Guidance
		?In-Plane Technique (Fig. 35E.1)
		?Out-of-Plane Confirmation (Fig. 35E.2)
		Alternative
		?Optimal Image (Fig. 35E.4)
		Suggested Reading
	36 - Iliac Crest Bone Marrow Biopsy/Aspiration
		References
	36A - Iliac Crest Bone Marrow Aspiration: Fluoroscopic Guidance
		?Trajectory View (Fig. 36A.1)
		?Optimal Needle Position in Multiplanar Imaging
		OPTIMAL NEEDLE POSITIONING IN THE ANTEROPOSTERIOR VIEW (FIG. 36A.2)
		OPTIMAL NEEDLE POSITIONING IN THE CONTRALATERAL OBLIQUE VIEW (FIG. 36A.3)
		OPTIMAL NEEDLE POSITIONING IN THE LATERAL VIEW (FIG. 46A.4)
	36B - Iliac Crest Bone Marrow Aspiration: Ultrasound Guidance
		?In-Plane Technique (Fig. 36B.1)
		?Optimal Images (Figs. 36B.2 and 36B.3)
		?Suboptimal Needle Placement and Images (Fig. 36B.4)
		References
Appendices - Spinal Intervention Reference Tables and Guidelines
	INTRODUCTION
	Appendix A1Anticoagulation and Antiplatelets
INDEX
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	X
	Z
IBC