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 (TFESI) for L4 radiculopathy secondary to a disc herniation at L3/L4 is not explicitly stated in the provided studies.
- However, a study by 1 suggests that a preganglionic approach, which involves injecting at the level of the supra-adjacent intervertebral disc, may be more effective than a conventional approach for treating lumbar radiculopathy.
- In the case of L4 radiculopathy secondary to a disc herniation at L3/L4, this would suggest performing the TFESI at the L3-L4 level.
- Another study by 2 describes a case where a TFESI was performed at the L3-L4 level for a patient with L3-L4 and L4-L5 radiculopathy, but notes that Kambin's retrodiscal approach may increase the incidence of intradiscal needle entry and injection.
- Studies by 3, 4, and 5 provide evidence for the efficacy of TFESI in relieving lumbar radicular pain, but do not specifically address the optimal level for injection in the case of L4 radiculopathy secondary to a disc herniation at L3/L4.
Key Findings
- TFESI is a effective treatment for lumbar radiculopathy, with studies showing significant pain reduction and improvement in function 3, 4, 5.
- The preganglionic approach may be more effective than the conventional approach for treating lumbar radiculopathy 1.
- The optimal level for TFESI in the case of L4 radiculopathy secondary to a disc herniation at L3/L4 is not explicitly stated in the provided studies.