Technical Aspects

The technical approach to the disc is the same as that used for discog-raphy and for other percutaneous intervertebral disc procedures. We use an 18- to 20-gauge Chiba needle inserted with a posterior paravertebral oblique approach under CT or fluoroscopic guidance (Figures 19.1 and 19.2). The L5-S1 disc space is not always an easy target and may require a further 30° craniocaudal inclination of the needle. Once the needle has been positioned in the center of the disc, the gas mixture is injected into the disc and into the epidural and intraforam-inal spaces at the concentrations and amounts described earlier (Figure 19.3). We no longer perform discography before percutaneous treatment. A CT scan is obtained before therapy to rule out the presence of a heterotopic loop of bowel that might be injured or contribute to disc infection.

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