Transforaminal epidural steroid injection
Alternative treatment for chronic radicular pain.
More efficacious as it injects the concentrated steroid and anaesthetic solution selectively at the pathologic site or along the dorsal root ganglion.
Types
Transforaminal cervical epidural steroid injection
Transforaminal lumbar epidural steroid injection.
The use of digital subtraction angiography (DSA), imaging to exclude vascular uptake during TFESI increases radiation dose over conventional fluoroscopy (CF). computed tomography CT/fluoroscopy incurs additional dose beyond most DSA. Minimizing radiation dose by limiting DSA and CT/F use to spine segments or clinical situations involving higher risk may be desirable. However, the incremental radiation doses incurred by DSA or CT/F are of such low magnitude that health risks cannot currently be estimated 1).
Anecdotal report suggests that provocation of pain during epidural steroid injection (ESI) that is concordant with typical radicular symptoms predicts pain outcome following injection. However, limited evidence exists that substantiates this theory. Additionally, there is a paucity of literature investigating factors associated with the provocation of pain during ESI.
Outcome
Provocation of concordant radicular pain does not predict pain relief at short-term follow-up after a transforaminal ESI. Foraminal stenosis, nerve root impingement, and lack of a medial-superior contrast flow pattern are associated with pain during the transforaminal ESI. Thus, clinicians should be aware of these radiologic and procedural risk factors for inciting pain during transforaminal ESI 2).