“True” Lateral Imaging for Lumbar Radiofrequency Medial Branch Neurotomy

When planning a targeted interventional pain procedure involving the injection of corticosteroid combined with a local anesthetic, consideration should be given to the possible formation of large crystal precipitates. Any crystal larger than the diameter of an RBC (6–8 microns) could potentially obstruct arterioles, with ensuing occlusion and tissue ischemia. This is of particular concern when considering the implications of inadvertent arterial injection during TFESI or any other procedure performed in close proximity to the arterial supply of neural structures.