Fluoroscopic guided Lumbar facet joint injection

The patient lies prone.

Identify the “magic triangle” at the level you wish to inject.  If the facets are grossly degenerate this may be invisible.  In these instances intra-articular injection is more difficult to achieve and CT is advised.

The L5/S1 triangle is made up of the lamina of L5 (lateral margin), superior articular process of S1 (medial margin) and the superimposed vertebral margin (the base)

Make your puncture point (yellow) just medial to the triangle and advance the needle towards it (red). Occasionally a slight give is felt as you enter the joint.

Alternative approaches include rotating the patient/tube to see the joint in profile and direct the needle to this. As the lower facets are curved joint surfaces, profiling does not always identify the true joint margin.

Inject a small amount of contrast.  If the location is correct, you will see filling of the superior and inferior recesses confirming your position. Inject the therapeutic agent.

The above should be regarded as guidance only. All medical procedures require adequate training and supervision by an expert. Full informed consent ahould be obtained.

Choose another heading