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PLDD is performed under dual guidance with a combination of CT and fluoroscopy. Two mobile fluoroscopy monitors are placed in front of the physician along with a CT monitor. At any time the operator can switch from CT to fluoroscopy and vice versa. Once the entry point is determined by CT, a lateral fluoroscopy view is obtained at the desired disk level. In this way, the operator can visualize the pathway and the correct angulation of the needle. In most of the cases the angulation is oblique in the three planes, especially at L5-S1 level.

Fig 13: the patient is placed in prone position. dual guidance CT + fluoroscopy

Fig 15: dual-guidance CT

Fig 14: dual-guidance fluoroscopy