lcole7465
Expert
I don't think I've ever came across this scenario. Since the contrast did not spread at L4 and he moved to L3, this would still only be 2 levels? The TFE report reads:
"The pedicle and the superior articular process of the above facet and the "neck of the scotty dog" were all visualized. After adequate local anesthesia, a 22-gauge, 5-inch spinal needle was inserted using down-the-barrel-of-the-needle technique. The needle was advanced into the posterior aspect of the foramen and then advanced anteriorly toward the 6 o'clock position on the pedicle . No paresthesia were noted. The contrast did not spread well so repeated the same procedure at L3 Then 0.5 mL of contrast was injected and spread medially around the pedicle and into the epidural space and the nerve root was visualized. Dexamethasone 5 mg plus 1 mL of 0.25% preservative-free bupivacaine was injected. The needle was flushed and removed.
For the level of left L5
The pedicle and the superior articular process of the above facet and the "neck of the scotty dog" were all visualized. After adequate local anesthesia, a 22-gauge, 5-inch spinal needle was inserted using down-the-barrel-of-the-needle technique. The needle was advanced into the posterior aspect of the foramen and then advanced anteriorly toward the 6 o'clock position on the pedicle . No paresthesia were noted. Then 0.5 mL of contrast was injected and spread medially around the pedicle and into the epidural space and the nerve root was visualized. Dexamethasone 5 mg plus 1 mL of 0.25% preservative-free bupivacaine was injected. The needle was flushed and removed."
Thank you
"The pedicle and the superior articular process of the above facet and the "neck of the scotty dog" were all visualized. After adequate local anesthesia, a 22-gauge, 5-inch spinal needle was inserted using down-the-barrel-of-the-needle technique. The needle was advanced into the posterior aspect of the foramen and then advanced anteriorly toward the 6 o'clock position on the pedicle . No paresthesia were noted. The contrast did not spread well so repeated the same procedure at L3 Then 0.5 mL of contrast was injected and spread medially around the pedicle and into the epidural space and the nerve root was visualized. Dexamethasone 5 mg plus 1 mL of 0.25% preservative-free bupivacaine was injected. The needle was flushed and removed.
For the level of left L5
The pedicle and the superior articular process of the above facet and the "neck of the scotty dog" were all visualized. After adequate local anesthesia, a 22-gauge, 5-inch spinal needle was inserted using down-the-barrel-of-the-needle technique. The needle was advanced into the posterior aspect of the foramen and then advanced anteriorly toward the 6 o'clock position on the pedicle . No paresthesia were noted. Then 0.5 mL of contrast was injected and spread medially around the pedicle and into the epidural space and the nerve root was visualized. Dexamethasone 5 mg plus 1 mL of 0.25% preservative-free bupivacaine was injected. The needle was flushed and removed."
Thank you