What is Fluoroscopy?
Fluoroscopy is a form of X-ray imaging guidance that helps your doctor to locate the internal injection site where an injection, such as a steroid or joint injection is to be administered for pain relief.
Fluoroscopy is like GPS (global positioning system) navigation for the tip of an injection needle. GPS lets you know where you are in relation to your surroundings to help you find exactly what you’re looking for. When you use GPS, you’re less likely to take a wrong turn or to overshoot your stop, and you know precisely when you’ve arrived at your intended location.
Fluoroscopy provides real-time moving images of an injection needle working its way into your tissue.
Fluoroscopy Guided Injection, Advanced Pain Management Los AngelesUsing X-ray imaging technology and a high-contrast fluid dye, fluoroscopy can help your doctor to locate the precise point where medication should be injected.
Fluoroscopy increases your doctor’s accuracy to pinpoint your source of pain, and improves the efficacy of your pain relief treatment.
Needle placement is key
Steroid and epidural injections can provide immense relief from chronic and acute orthopedic pain, but the treatment is only effective when it is correctly administered.
Most orthopedic pain originates in teeny, tiny, delicate spaces, either between facet joints, epidural spaces, or within the spinal cord canal. For this reason, accuracy in the placement of the needle is key.
Blind steroid and epidural injections are risky
The thickness of skin, muscle, fat, and other soft tissues varies widely from patient to patient, and navigating these waters can be dangerous. Injections of anti-inflammatory, steroid, epidural steroid medications can help diagnose the source of pain, as well as alleviate the discomfort.
Attempting to administer an injection without guidance is called doing it “blind.” According to a systematic review, up to 52% of caudal injections and 30% of lumbar injections were incorrectly placed when performed blind.
Fluoroscopic injections are safer and more effective
On the other hand, fluoroscopy with high-contrast dye can dramatically improve your doctor’s ability to correctly place your injection.
Even experienced physicians should use fluoroscopic guidance. In a study of over 300 caudal epidural injections, less-experienced doctors got the right spot only 50.6% of the time, and more-experienced physicians did only marginally better, getting it right 61.7% of the time.
How is the Fluoroscopy Guided Injection performed?
For most injections done fluoroscopically, the procedure is done with the patient lying either on their back or stomach based on diagnosis and source of pain. Some cervical or neck area facet injections are done in other positions. All injections are done under x-ray guidance. EKG, blood pressure cuff and blood oxygen-monitoring devices are utilized when a patient receives intravenous sedation.
The patient will be positioned to treat the source of pain on the x-ray table. The area will be well-prepped and cleansed for the procedure. The physician numbs a small area of skin with an anesthetic (numbing medication). After the area is numb the physician uses x-ray guidance (fluoroscopy) to direct a very small needle into the target injection site. A fluoroscope is an x-ray machine that allows the physician to see an x-ray image while performing the injection. Once the correct position is confirmed, the anesthetic and steroid will be injected, and the needle is removed.
The first injection is simply a local anesthetic to numb the injection site, which will be delivered into the skin right above the target site. The next injection will contain high-contrast agent (contrast dye), more local anesthetic, and a corticosteroid, anti-inflammatory medication. This injection will be inserted into the identified source of pain.
The high-contrast dye helps the physician to confirm that needle placement is correct.
The local anesthetic will provide rapid pain relief, so that you can tell the doctor if that area was indeed the source of pain.
The corticosteroid acts as an anti-inflammatory medication to provide long-lasting pain relief.
What are the risks of Fluoroscopy?
It is always a good idea to keep a record of your past medical history of radiation exposure, such as previous scans, x-rays and other types of imaging technique procedures so that you can inform your doctor. Possible risks associated with radiation exposure may be related to the cumulative number of X-ray examinations and/or treatments over a long duraton of time.
Radiation exposure during pregnancy may lead to birth defects. If you are pregnant or suspect that you may be pregnant, notify your doctor for full disclosure.
If contrast dye is used, there is a risk for allergic reaction to the dye. Patients who are allergic to or sensitive to medications, contrast media, iodine, or latex should notify their doctor to anticipate possible side effects.
What to expect after the procedure
In the first day or two after injections, the patient may experience some soreness near the injection site. Some local tenderness may be experienced for a couple of days after the injections. Using an ice pack three or four times a day may help alleviate this. This is a common result of the anesthetic wearing off before the anti-inflammatory effects have kicked in.
The patient should go easy during this period of time and expect greater pain relief on the second or third day.