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Lumbar Facet Joint Injection
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with TPI (Lumbar Facet)
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with SI Joint
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PREOPERATIVE DIAGNOSIS
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TPI Field
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PreOp
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POSTOPERATIVE DIAGNOSIS
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TPI Field
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PostOp
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PROCEDURE
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TPI Field
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Procedure
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TIVA [Yes] / Local [No]
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IV Sedation [Yes] / Local [No]
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MAC [Yes] / Local [No]
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INDICATION
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TPI Field
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Indication
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OPERATIVE PROCEDURE
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Prep
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Facet Joint Location
• • •
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Spinal Needle Size
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Anesthetic % / Amount
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Depo-Medrol Dose / Level
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Procedure Comments
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SIJ Prep
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SI Joint Location
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Lumbar Medial Branch Block
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with SI Joint / TPI
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PREOPERATIVE DIAGNOSIS
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PreOp
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POSTOPERATIVE DIAGNOSIS
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PostOp
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PROCEDURE
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Procedure
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TIVA [Yes] / Local [No]
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IV Sedation [Yes] / Local [No]
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INDICATION
• • •
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OPERATIVE PROCEDURE
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Prep
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Facet Joint Location
• • •
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Spinal Needle Size
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Target are L1 though L5 or L5-S1
• • •
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Procedure Comments
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SIJ Prep
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SI Joint Location
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Procedure Comments
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Local Anesthetic
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Cervical Facet Joint Injection
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with TPI (Cervical Facet)
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PREOPERATIVE DIAGNOSIS
|
TPI Field
|
|
POSTOPERATIVE DIAGNOSIS
|
TPI Field
|
|
PROCEDURE
|
TPI Field
|
|
TIVA [Yes] / Local [No]
|
IV Sedation [Yes] / Local [No]
|
|
INDICATION
|
TPI Field
|
|
OPERATIVE PROCEDURE
|
|
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Prep
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Facet Joint Location
• • •
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Steroid
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Anesthetic
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Procedure Comments
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Cervical Medial Branch Block
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PREOPERATIVE DIAGNOSIS
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PREOP DX
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POSTOPERATIVE DIAGNOSIS
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POSTOP DX
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PROCEDURE
|
PROCEDURE
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IV Sedation [Yes] / Local [No]
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MAC [Yes] / Local [No] (SPRING)
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MAC [Yes] / Local [No]
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INDICATION
• • •
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OPERATIVE PROCEDURE
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Prep
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Nerve Level Location
• • •
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Procedure Comments
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TRIGGER POINT INJECTION (TPI)
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Cervical (Right / Left)
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Cervical (B/L)
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Cervical / Trapezius (Right / Left)
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Cervical / Trapezius (B/L)
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Trapezius (Right / Left)
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Trapezius (B/L)
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Thoracic (Right / Left)
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Thoracic (B/L)
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Lumbar (Right / Left)
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Lumbar (B/L)
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TPI Comments
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Tolerated well? Yes / No
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Tolerated Procedure Free Write
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Recovery / Discharge
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Recovery / Discharge Free Write
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Fluoroscopy Image #1
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Fluoroscopy Image #2
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Fluoroscopy Image #3
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Fluoroscopy Image #4
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Fluoroscopy Image #5
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