There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the Research
Transforaminal Epidural Steroid Injection for L4 Radiculopathy
- The level at which to perform a transforaminal epidural steroid injection for L4 radiculopathy is not explicitly stated in the provided studies, but we can infer the appropriate level based on the information given.
- According to the study 1, for L4 radiculopathy, the injection should be performed at the level of the supra-adjacent intervertebral disc, which would be the L3-L4 level.
- Another study 2 mentions that Kambin's retrodiscal approach may increase the incidence of intradiscal needle entry and injection, but it does not specify the level for L4 radiculopathy.
- The study 3 reports that L5 was the most commonly affected level, but it does not provide information on the specific level for L4 radiculopathy.
- The study 4 discusses the efficacy of two-level transforaminal epidural steroid injections, but it does not specify the level for L4 radiculopathy.
- Based on the study 5, which characterizes the dimensions of Kambin's Triangle at different lumbar levels, the height and width of Kambin's Triangle at the L3-L4 level are 17 mm and 11 mm, respectively, which may be relevant for performing a transforaminal epidural steroid injection at this level.
- Therefore, based on the available information, it appears that the L3-L4 level may be the appropriate level for performing a transforaminal epidural steroid injection for L4 radiculopathy, as suggested by the study 1.
Key Points
- The level for transforaminal epidural steroid injection for L4 radiculopathy is likely L3-L4, based on the study 1.
- Kambin's retrodiscal approach may increase the incidence of intradiscal needle entry and injection, as mentioned in the study 2.
- The dimensions of Kambin's Triangle at the L3-L4 level are 17 mm and 11 mm, respectively, as reported in the study 5.