S1 foraminal neuroplasty using a reference spinal needle. A technical note.

Background: Radicular pain may originate from various etiologies, among which epidural fibrosis is a significant contributor. Epidural scarring can induce pain through multiple pathophysiological mechanisms, notably by entrapping spinal nerve roots and disrupting the integrity of the myelin sheath. Objective: To present a safe and practical technique for performing neuroplasty via the S1 foramen, utilizing a Tuohy or introducer needle guided by a reference spinal needle under fluoroscopic imaging. This caudal-to-cephalic approach ensures precise catheter advancement and builds upon previously described methods by Silva et al. Design: Technical note. Methods: For the described approach, we considered the anatomical dimensions of the sacral canal, with particular attention to the measurements at the level of the S1 foramen. This measurement is crucial, as it determines the available space for positioning the introducer needle and safely advancing the neuroplasty catheter in a caudal-to-cephalic direction. Conclusion: This technique enables safer and more effective S1 foraminal neuroplasty by incorporating depth information through the use of reference spinal needles under fluoroscopic guidance. It facilitates tunnel-view access, which was previously unattainable, and improves procedural outcomes, particularly benefiting clinicians with less experience in fluoroscopically guided interventions.