Lumbar Ventral Epidural Approach

The utilization of transforaminal epidural steroid injections (TFESIs), an elective diagnostic and therapeutic spinal procedure, has risen dramatically over the past decade. The transforaminal technique uses a needle that approaches the posterolateral aspect of the intervertebral foramen. Despite the superiority of the transforaminal route, transforaminal blocks have been associated with devastating neurological complications, particularly paraplegia. Since the radiological target advocated for transforaminal injections matches the superoanterior portion of the foramen, it comes as no surprise that this approach renders radiculomedullary arteries vulnerable to injury. The author uses retrograde interlaminar ventral epidural steroid injection with catheters to obtain a theoretically advantageous placement of epidural corticosteroid. Epidurography of such injections does demonstrate that this approach more frequently achieves coverage of both the putative disc source of nerve irritation and of the affected segmental nerve.