Lumbar transforminal epidural steroid injection (fluoroscopic guided)
Presentation
Ongoing left leg radicular pain, no benefit from conservative measures. MRI showed L5 compression in the left L4/5 subarticular zone.
Patient Data
A 22-gauge Quincke needle is used to target the supraneural portion of the exiting left L5 nerve, using an infrapedicular approach under fluoroscopy. The needle tip is confirmed to be in the superior and posterior quadrant of the infrapedicular zone on the lateral image. Injection of iodinated contrast confirmed a desired extravascular needle tip position, with epidural spill.
Image taken after half of the steroid injectate was administered, which shows dispersal of the iodinated contrast.
Case Discussion
Transforminal epidural steroid injections (TFESI) are often called 'nerve root' injections in clinical practice. Epidural spill is desired in cases where the nerve is compromised in the subarticular zone, as it is the exiting nerve root that is targeted in these injections.
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