Fluoroscopically Guided Epidural Injections of the Cervical and Lumbar Spine

Radiographics. Mar-Apr 2017;37(2):537-561. doi: 10.1148/rg.2017160043. Epub 2016 Dec 9.


Advances in imaging and the development of injection techniques have enabled spinal intervention to become an important tool in managing chronic spinal pain. Epidural steroid injection (ESI) is one of the most widely used spinal interventions; it directly delivers drugs into the epidural space to relieve pain originating from degenerative spine disorders-central canal stenoses and neural foraminal stenoses-or disk herniations. Knowledge of the normal anatomy of the epidural space is essential to perform an effective and safe ESI and to recognize possible complications. Although computed tomographic (CT) or combined CT-fluoroscopic guidance has been increasingly used in ESI, conventional fluoroscopic guidance is generally performed. In ESI, drugs are delivered into the epidural space by interlaminar or transforaminal routes in the cervical spine or by interlaminar, transforaminal, or caudal routes in the lumbar spine. Epidurography is usually performed before drug delivery to verify the proper position of the needle in the epidural space. A small amount of contrast agent is injected with fluoroscopic guidance. Familiarity with the findings on a typical "true" epidurogram (demonstrating correct needle placement in the epidural space) permits proper performance of ESI. Findings on "false" epidurograms (demonstrating incorrect needle placement) include muscular staining and evidence of intravascular injection, inadvertent facet joint injection, dural puncture, subdural injection, and intraneural or intradiscal injection. ©RSNA, 2016 An earlier incorrect version of this article appeared online. This article was corrected on December 22, 2016.

Publication types

  • Review

MeSH terms

  • Analgesia, Epidural / methods*
  • Cervical Vertebrae*
  • Chronic Pain / drug therapy*
  • Contrast Media
  • Fluoroscopy
  • Humans
  • Injections, Epidural*
  • Lumbar Vertebrae*
  • Pain Management
  • Punctures
  • Radiography, Interventional / methods*
  • Spinal Diseases / drug therapy*


  • Contrast Media