Difficult Lumbar TFESIs

Even with more than a few years of experience under my belt, with more and more elderly and obese patients I’m finding that even with basic lumbar TFESI the frequency with which I cannot accomplish “plan A”, such as a L5-S1 TFESI using my go to subpedicular approach has risen. More tilt, more oblique, still giant facet in the trajectory view. A few attempts to corkscrew around the big joints unsuccessful. Move on to retrodiscal/Kambin triangle. Not infrequently with a badly collapsed disc... Difficult Lumbar TFESIs
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Source Type: forums