Another issue with usage of intra-lesional steroids is the size, length and thickness of the needle used to inject the keloid lesions. Some physicians falsely believe that a large and thick needle should be used to inject large keloid lesions. This belief comes from the fact that injecting some old and dense keloid lesions is a rather difficult task. In treating keloid lesions, the smaller and thinner the needle is, the less damage it causes to the keloid tissue. Dr. Tirgan only uses the smallest and thinnest needles, those that are used to inject insulin under the skin. With this method, Dr. Tirgan is able to inject any keloid.
The needle is smaller in size than that used during a conventional epidural approach. The procedure is performed with the patient lying on their belly using fluoroscopic (real-time x-ray) guidance, which helps to prevent damage to the nerve root. A radiopaque dye is injected to enhance the fluoroscopic images and to confirm that the needle is properly placed (See Figure 2). This technique allows the glucocorticoid medicine to be placed closer to the irritated nerve root than using conventional interlaminar epidural approach. The exposure to radiation is minimal.