Is Fluoroscopy (C-Arm, x-ray machine) medically necessary?
Historically, the epidural space was accessed from the back through the interlaminar approach or inferiorly through the caudal approach, often without the use of fluoroscopy, an imaging technique, similar to an x-ray, used by physicians to obtain real-time images of internal structures. A major criticism of these blind approaches (without fluoroscopy) is lack of target specificity. Even when performed by experienced clinicians, blind epidural injections result in incorrect placement of the needle 25 to 40 % of the time. Injection of contrast medium (substance used to make structures more visible) is also strongly recommended to confirm correct needle placement within the epidural space. For these reasons, blind epidural injections have been abandoned in favor of a fluoroscopically guided approach. 1) Interlaminar Epidural Steroid Injections (ESI) The interlaminar epidural approach involves insertion of an epidural needle midway between two adjacent vertebrae. For lumbar and thoracic in
