Open AccessAlternative Approach for Lumbar Transforaminal Epidural Steroid Injections
Author(s) -
Jing Zhu
Publication year - 2011
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2011/14/331
Subject(s) - medicine , epidural space , radicular pain , surgery , intervertebral foramen , lumbar , anesthesia , epidural steroid injection , anterior spinal artery , spinal cord , nerve root , lumbar arteries , subarachnoid space , low back pain , cerebrospinal fluid , alternative medicine , pathology , psychiatry
The traditional superoanterior approach for transforaminal epidural steroidinjection (TFESI) carries a risk of complication by obstructing arterialflow to the anterior portion of the spinal cord by puncturing the spinalradicular artery that passes through the superoanterior foraminal zoneor “safe triangle” zone, which does not describe vascular safety, butrather describes neural safety. Consequently, multiple disasters have beendescribed in recent years with transforaminal epidural injections. They areutilized extensively even though their effectiveness has been debated.Here we describe a dorsal technique through transforaminal epiduralinjections to place the tip of the needle immediately dorsal to the dorsalroot ganglion. Multiple different techniques have been discussed anddescribed in recent years, the majority of them to avoid the radicular arteryinjection.The primary goal of this paper is to describe another posterior approach toplace the tip of spinal needle directly toward the posterior epidural spaceto avoid puncturing the spinal radicular artery and minimize nerve rootpenetrations while delivering medication into the epidural space throughthe foramen.Key words: transforaminal epidural injection, selective nerve root block,safe triangle zone, radicular artery, radiculomedullary artery, lumbar spinalartery, lumbar vein, intervertebral vein