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Since their inception in 1985, release to the pain management community in 1987, and assignment of an CPT code in 2000, epidurography

EpidurogramInnervation The Level

Figure 10.14. (A) Epidurogram demonstrating filling defect on right at the C7 nerve root level. (B) Cannulation of the right C7 medial neuroforamen.

Figure 10.14. (A) Epidurogram demonstrating filling defect on right at the C7 nerve root level. (B) Cannulation of the right C7 medial neuroforamen.

Epidurogram

Figure 10.14. (C) Epidurolysis of the right C7 with transforaminal decompression (grade 3/4A).

Figure 10.14. (C) Epidurolysis of the right C7 with transforaminal decompression (grade 3/4A).

and epidurolysis of adhesions are slowly becoming part of our standard of care. While many anesthesiologists still provide epidural steroid injections with a simple hanging drop or loss-of-resistance technique performed without benefit of fluoroscopy, the more sophisticated, fluoroscopically directed, lesion-specific administration of epidural steroid has gained favor. We now have the ability to provide a definitive diagnosis of pathology capable of producing the signs and symptoms of low back pain and radiculopathy, often in the absence of confirmatory radiological evidence. We now understand that abnormalities seen on images produced by magnetic resonance, computed tomography, or myelography do not necessarily cause pain, while normal-appearing structures can be associated with significant disabling pain. A pain physician has the unique opportunity and responsibility to believe a patient's pain complaint while remaining vigilant to any and all findings that might indicate symptom magnification.

Epidurography began as a diagnostic procedure, but the advance of epidurolysis of adhesions provides real long-term benefit to patients suffering with intractable and underdiagnosed or untreated pain. We will need continued development of improved methods to treat that suffering, just like the treatments addressed in this chapter. Innovation thrives where need is great.

Racz Adhesiolysis Epidurolisis

Figure 10.15. (A) Cannulation of the left C7 neuroforamen with filling defect of proximal nerve root. (B) Epidurolysis of the left C7 nerve root with both distal and proximal spread (grade 3/5B) and slight cephalad filling of the left C6.

Figure 10.15. (A) Cannulation of the left C7 neuroforamen with filling defect of proximal nerve root. (B) Epidurolysis of the left C7 nerve root with both distal and proximal spread (grade 3/5B) and slight cephalad filling of the left C6.

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