From the Guidelines
Transforaminal epidural injections can be performed at one level, and this approach is considered in certain cases, such as when the site of dural puncture is known, and the procedure should be performed ideally at or 1 space below this level 1. When considering the performance of transforaminal epidural injections, several factors come into play, including the patient's specific condition, the clinical presentation, and the known site of dural puncture.
- The decision to perform the injection at one level or multiple levels depends on various considerations, including the distribution of pain, neurological findings, and imaging results.
- In cases where the pathology is clearly localized to one specific nerve root or intervertebral level, a single-level injection may be preferred.
- However, when symptoms span multiple dermatomes or imaging shows pathology affecting multiple nerve roots, multi-level injections might be considered. The procedure involves injecting a mixture of local anesthetic and corticosteroid into the epidural space through the neural foramen, with the goal of delivering anti-inflammatory medication directly to the site of nerve irritation to reduce inflammation and provide pain relief.
- The choice of medication, including the type and dose of local anesthetic and corticosteroid, is crucial and must be tailored to the individual patient's needs and medical history.
- The use of radiologic guidance for the transforaminal approach can be considered, especially in cases of prior laminectomy near the site of dural puncture or after unsuccessful interlaminar epidural blood patch, as recommended by recent guidelines 1.
From the Research
Transforaminal Epidural Injections
- Transforaminal epidural injections can be administered at one level, depending on the clinical scenario and the target nerve root 2.
- The transforaminal approach is typically used when it is more desirable to target a specific nerve root, and the injection is usually done at the level of the affected nerve root 2, 3.
- The evidence suggests that transforaminal epidural injections can provide significant pain relief for patients with lumbar nerve root pain, and the injections are usually done at one level 4, 5.
- However, the number of injections and the frequency of administration can vary depending on the patient's condition and the physician's preference, with some physicians reporting allowing up to four injections at a given spinal segmental level per year 4.
Key Considerations
- Proper technique is essential to minimize the rate of rare but occasionally severe complications associated with transforaminal epidural injections 2, 3.
- The choice of corticosteroid dose and frequency of administration can vary among physicians, and there is a need for additional research to determine the optimal dose and frequency 4.
- Transforaminal epidural injections can be an effective therapy for patients with disc herniation or radiculitis, and the use of local anesthetic with or without steroids can provide significant improvement in pain and function 5.