Technical Note: Dual Puncture Technique for Interlaminar Approach to Lumbar Epidural Steroid Injection in the Management of Patients with Low Back Pain Associated with Lumbar Stenosis or Prior Lumbar Spine Surgery

A technical modification for performing fluoroscopy-guided interlaminar lumbar ESIs by using a dual-puncture technique was used in 5 patients with symptomatic lumbar stenosis and 1 patient with prior lumbar spine surgery. Each patient had a prior fluoroscopy-guided single-level interlaminar lumbar ESI, which did not provide significant pain relief at 3 weeks. The procedure was then repeated with the dual-puncture technique by using 2 separate puncture sites for epidural space access via an interlaminar approach. Epidurography with a low-osmolar nonionic contrast agent was performed to confirm a more satisfactory spread of contrast agent about the level of suspected pathology. This was followed by ESI. At 3-month follow-up, each patient experienced a therapeutic benefit, defined as greater than a 3-point reduction in their numeric pain score. Dual-puncture interlaminar ESI may be an effective technique in the management of patients with low back pain in situations in which the distribution of medication into the epidural space may be compromised (due to stenosis, adhesions, or anatomic variants in the epidural space) as demonstrated on epidurography.