Significance of Live Fluoroscopy in Detecting Intravascular Drug Spread During Caudal Epidural Injections

Caudal epidural injection is one of the most common procedures to treat pain associated with conditions such as lumbar radiculopathy and lumbar canal stenosis. Despite the benefits of portability, needle visualization, and radiation exposure minimization, ultrasound cannot reliably distinguish between intravascular, intrathecal, and epidural injection.[1] Fluoroscopic guidance is the gold standard method for performing caudal epidural injections to prevent intravascular or intrathecal injection.[2] Here, the clinical images demonstrate the importance of performing a caudal epidural injection under live fluoroscopy. The first part of the image shows needle placement in the caudal canal and the characteristic “Christmas tree” pattern of dye spread [Figure 1]. The second part of the image highlights the unintended intravascular dye spread pattern [Figure 2]. In interventional pain management, real-time fluoroscopic guidance is critical to avoid serious complications, such as the intravascular injection of drugs.Figure 1: (a) needle placed in the caudal canal under fluoroscopy in the lateral view. (b) typical christmas tree pattern of epidural dye spread in the anteroposterior view. (c) clinical PhotographFigure 2: (a) intravascular dye spread in lateral view (b) intravascular dye spread in anteroposterior view (c) remains for the clinical photographFinancial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.