David E. Fish, MD, MPH, Paul C. Lee, BS, MSIV, Daniel B. Marcus, MD

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Presentation transcript:

The S1 “Scotty Dog”: Report of a Technique for S1 Transforaminal Epidural Steroid Injection David E. Fish, MD, MPH, Paul C. Lee, BS, MSIV, Daniel B. Marcus, MD Archives of Physical Medicine and Rehabilitation Volume 88, Issue 12, Pages 1730-1733 (December 2007) DOI: 10.1016/j.apmr.2007.07.041 Copyright © 2007 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 1 A 58-year-old woman with 9 months of pain in her lower back radiating to her left foot through the back of her leg without neurologic loss. Magnetic resonance imaging revealed disk herniation at L5-S1 with apex deviated to the left causing minor impingement of the S1 nerve root. Electromyography suggested an S1 radiculopathy. After conservative options failed, a combined L5 and S1 transforaminal ESI using the procedure described improved symptoms more than 75% at 3 months. (A) The oblique view with and without highlights of the Scotty dog formation. (B) Simultaneous placement of needles in L5 and S1 foramen in oblique view with and without highlights of the Scotty dog formation. (C) The lateral view. (D) The AP view. (E) The AP view with contrast. Archives of Physical Medicine and Rehabilitation 2007 88, 1730-1733DOI: (10.1016/j.apmr.2007.07.041) Copyright © 2007 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 1 A 58-year-old woman with 9 months of pain in her lower back radiating to her left foot through the back of her leg without neurologic loss. Magnetic resonance imaging revealed disk herniation at L5-S1 with apex deviated to the left causing minor impingement of the S1 nerve root. Electromyography suggested an S1 radiculopathy. After conservative options failed, a combined L5 and S1 transforaminal ESI using the procedure described improved symptoms more than 75% at 3 months. (A) The oblique view with and without highlights of the Scotty dog formation. (B) Simultaneous placement of needles in L5 and S1 foramen in oblique view with and without highlights of the Scotty dog formation. (C) The lateral view. (D) The AP view. (E) The AP view with contrast. Archives of Physical Medicine and Rehabilitation 2007 88, 1730-1733DOI: (10.1016/j.apmr.2007.07.041) Copyright © 2007 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions