A alternative approach for lumbar transforaminal epidural steroid injection—Far lateral approach

Pain Practice ◽  
2021 ◽  
Author(s):  
Jui‐Hsuan Liu ◽  
Chengwei Soo ◽  
Ying‐Chun Lin ◽  
Chia‐Shiang Lin
Keyword(s):  
Steroid Injection ◽  
Lateral Approach ◽  
Epidural Steroid Injection ◽  
Alternative Approach ◽  
Far Lateral Approach ◽  
Transforaminal Epidural Steroid Injection ◽  
Far Lateral ◽  
Epidural Steroid

scholarly journals The Efficacy of Transforaminal Epidural Steroid Injection by the Conventional Technique in FarLateral Herniation of Lumbar Disc

2012 ◽  
Vol 5;15 (5;9) ◽  
pp. 415-420
Author(s):  
Joon-Hee Park
Keyword(s):  
Oswestry Disability Index ◽  
Steroid Injection ◽  
Lumbar Disc ◽  
Conventional Technique ◽  
Epidural Steroid Injection ◽  
Leg Pain ◽  
Significant Difference ◽  
Transforaminal Epidural Steroid Injection ◽  
Far Lateral ◽  
Epidural Steroid

Background: Owing to the anatomical difference between the far lateral herniation of the lumbar disc (FHLD) and the intraspinal herniation of lumbar disc (iHLD), the outcome of transforaminal epidural steroid injections (TFESI) in patients with FHLD seems to be different from that in patients with iHLD. However, few studies have evaluated the efficacy of TFESI in FHLD. Objective: To evaluate and compare the efficacy of TFESI in FHLD and iHLD patients. Study Design: A retrospective design. Methods: There were 15 and 70 patients in the FHLD and iHLD groups, respectively. Patients received a fluoroscopically guided TFESI. Failure rates of TFESI were recorded, and questionnaires, including a visual analog scale (VAS) for leg pain and Oswestry Disability Index (ODI) were administered before the initial injection, at 2 weeks, 6 weeks, and 12 weeks after the injections. Results: There was no failure for TFESI in the iHLD group, while 9 patients had to undergo alternative blocks in the FHLD group due to lancinating leg pain when the needle was advanced for TFESI. In the iHLD group, there was a statistically significant improvement in the VAS and ODI score 12 weeks after injection. Considering only successful cases of the FHLD group, significant improvement in the VAS and ODI score was also demonstrated in the FHLD group 12 weeks after injection. Moreover, there was no statistically significant difference of the VAS and ODI between the both groups. Limitations: A relatively small numbers of cases were included in the FHLD group. Conclusion: The current study suggests that an alternative needle placement technique for TFESI appears to be necessary for FHLD patients. Key words: Far lateral herniation of lumbar disc, intraspinal herniation of lumbar disc, transforaminal epidural steroid injection, safe triangle, herniated lumbar disc, visual analog pain scale, Oswestry disability index, radiculopathy

scholarly journals Comparison of Incidences of Intravascular Injection between Medial and Lateral Side Approaches during Traditional S1 Transforaminal Epidural Steroid Injection

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Sang Jun Park ◽  
Shin Hyung Kim ◽  
Seon Ju Kim ◽  
Duck Mi Yoon ◽  
Kyung Bong Yoon
Keyword(s):  
Steroid Injection ◽  
Lateral Approach ◽  
Epidural Steroid Injection ◽  
Lateral Side ◽  
Intravascular Injection ◽  
Medial Approach ◽  
Transforaminal Epidural Steroid Injection ◽  
Injection Risk ◽  
Epidural Steroid ◽  
Injection Rates

Purpose. Intravascular injection rates are higher during traditional S1 transforaminal epidural steroid injection (TFESI) compared with lumbar transforaminal injection. We compared the incidences of intravascular injection between the medial and lateral approaches to the S1 foramen during S1 TFESI. Materials and Methods. A total of 139 patients underwent one or more TFESIs (170 total injections). The patients received S1 TFESI by either medial or lateral side of S1 foramen under fluoroscopic anteroposterior view using digital subtraction method. The intravascular injection rates, epidural spread patterns, and contrast volumes required to reach the superior aspect of the L5-S1 intervertebral disc (SIVD) were compared between groups. Results. Intravascular injection rates during S1 TFESI were significantly lower in the medial approach compared with the lateral approach patients (4.9% versus 38.6%, resp., P<0.001). The medial approach group had more epidural spread to the L5-S1 SIVD than the lateral group (82.1% versus 58.8%, resp.); lower contrast volume amounts were required to extend the L5-S1 SIVD (1.46±0.48 versus 1.90±0.62, resp.). Conclusion. During S1 TFESI, approaching the needle towards the medial part of the S1 foramen may reduce intravascular injection risk.

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