Transforaminal epidural steroid injection efficacy

An epidural steroid injection involves bathing an inflamed nerve root in steroids (potent anti-inflammation medicine) in order to decrease the irritation of the nerve root that is causing pain.  Epidural steroid injections are most commonly used in situations of radicular pain, which is a radiating pain that is transmitted away from the spine by an irritated spinal nerve. Irritation of a spinal nerve in the low back (lumbar radiculopathy) causes pain that goes down the leg. Epidural injections also are used to treat nerve compression in the neck (cervical spine), referred to as cervical radiculopathy.

With a transforaminal epidural steroid injection (ESI), often referred to as a 'nerve block', the needle is placed alongside the nerve as it exits the spine, and medication is placed into the 'nerve sleeve'. The medication then travels up the sleeve and into the epidural space from the side. This allows for a more concentrated delivery of steroid into one affected area (usually one segment and one side). Transforaminal ESIs can also be modified slightly to allow for more specific coverage of a single nerve and can provide diagnostic benefit, in addition to improved pain and function.

Kenalog in blood - Derby et al. "Size and aggregation of corticosteroids used for epidural injections"

  • Depo-Medrol also formed large aggregations in the study by Tiso et al [6]
  • Celestone Soluspan formed large aggregations only in the Derby et al study  [7 ]
  • It is speculated that these large aggregates occlude smaller vessels, and thus lead to infarction .
  • Injection of methylprednisolone vs dexamethasone vs prednisolone into the vertebral artery of pigs – see summary of study here

    It is typically done with you lying on your stomach. Your blood pressure and oxygen levels will be monitored. In addition to your doctor and the x-ray technician, there will be a nurse in the room at all times. The skin on the back is cleaned with antiseptic solution. A separate area where a good vein is available is also cleaned with antiseptic solution. A small intravenous catheter is placed in the vein. After your doctor has placed the epidural needle near the affected area, he will draw about 20-25 cc of blood from your vein and will then gradually inject the blood.

    Transforaminal epidural steroid injection efficacy

    transforaminal epidural steroid injection efficacy

    It is typically done with you lying on your stomach. Your blood pressure and oxygen levels will be monitored. In addition to your doctor and the x-ray technician, there will be a nurse in the room at all times. The skin on the back is cleaned with antiseptic solution. A separate area where a good vein is available is also cleaned with antiseptic solution. A small intravenous catheter is placed in the vein. After your doctor has placed the epidural needle near the affected area, he will draw about 20-25 cc of blood from your vein and will then gradually inject the blood.

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