Is fluoroscopic guidance always used?

For spine-directed procedures, Dr. Migdale uses fluoroscopic guidance as standard practice. Some peripheral nerve targets (such as superficial peripheral nerves) may be more accurately and conveniently approached with ultrasound guidance instead. The choice between fluoroscopy and ultrasound depends on the depth, anatomy, and nature of the target structure.

How much radiation exposure is involved?

Fluoroscopic procedures involve X-ray radiation. The doses involved in a single interventional pain procedure are low — comparable to a few weeks of background radiation exposure. Dr. Migdale uses pulse fluoroscopy (intermittent rather than continuous imaging) and minimizes exposure time to keep radiation doses as low as reasonably achievable (ALARA principle).

Can I have fluoroscopic procedures if I'm pregnant?

Fluoroscopic procedures involving radiation to the lumbar spine or pelvis are generally avoided during pregnancy due to radiation exposure to the fetus. If you are pregnant or may be pregnant, please inform Dr. Migdale before any procedure. Ultrasound-guided alternatives may be appropriate in some situations.

Fluoroscopic-Guided Procedures | Dr. Roslyn Migdale

Overview

Fluoroscopy is real-time X-ray imaging that allows a physician to visualize needle position continuously throughout an interventional procedure. When performing epidural injections, nerve blocks, facet injections, or neuromodulation lead placements, fluoroscopic guidance provides a live view of the needle's position relative to bony landmarks and the target anatomy — allowing precise, accurate placement that cannot be achieved blindly. Dr. Migdale uses fluoroscopic guidance as standard practice for all spine-directed procedures, combined with contrast dye injection to confirm correct needle or lead position before any medication or stimulation is delivered.

Why Fluoroscopic Guidance Matters

Spine anatomy varies significantly between patients — previous surgery, degenerative changes, and individual anatomical variation can all shift landmarks from their textbook positions. Without real-time imaging, a needle directed by surface landmarks alone may miss its target or approach unintended structures. Fluoroscopic guidance eliminates this uncertainty, allowing the physician to watch the needle advance and confirm its position with contrast spread before delivering medication.

Contrast Injection: The Confirmation Step

Before any medication is injected in a fluoroscopically guided procedure, Dr. Migdale injects a small volume of radio-opaque contrast dye. This dye spreads within the anatomical space and is visible on X-ray — confirming that the needle is correctly positioned in the epidural space, adjacent to the target nerve, or within the joint capsule. This step is not optional — it is a patient safety measure that confirms accurate placement before any therapeutic agent is delivered.

What Procedures Use Fluoroscopic Guidance

Fluoroscopically guided procedures include: all epidural steroid injections (transforaminal, interlaminar, caudal); medial branch blocks and facet joint injections; sacroiliac joint injections and lateral branch blocks; sympathetic nerve blocks (stellate ganglion, lumbar sympathetic); radiofrequency ablation; and all neuromodulation lead placements (SCS, DRG stimulation).

Overview

Why Fluoroscopic Guidance Matters

Contrast Injection: The Confirmation Step

What Procedures Use Fluoroscopic Guidance

Frequently Asked Questions