Comparison of the Temporary Diagnostic Relief of Transforaminal Epidural Steroid Injection Approaches: Conventional versus Posterolateral Technique
I.S. Leea,b,
S.H. Kima,
J.W. Leea,
S.H. Hongc,
J.-Y. Choic,
H.S. Kanga,
J.W. Songb and
A.K. Kwond
a Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si Korea
b Department of Radiology, College of Medicine, Pusan National University & Medical Research Institute, Pusan National University, Busan, Korea
c Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
d Korea Health Industry Development Institute, Seoul, Korea
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Fig 1. Schematic description of the "safe triangle" for the conventional TFESI technique. The triangle is composed of a roof made up by the pedicle, a tangential base corresponding to the exiting nerve root, and the lateral border of the vertebral body. ST, safe triangle.
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Fig 2. Schematic description of the conventional and posterolateral TFESI techniques. In oblique view (A), the needle tip is located in the safe triangle using the conventional technique, and the median inferior margin of pedicle with posterolateral approach. The needle appears end-on in this view. Lateral view (B) shows the needle located in the anterior and superior aspect of a nerve root using the conventional technique and at the posterior aspect using the posterolateral technique. C, conventional TFESI; PL, posterolateral TFESI.
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Fig 3. Bar graph showing the number of patients with respect to temporary diagnostic relief according to the 5-point patient outcome scale when interviewed 2 weeks after TFESI. G0 = 0 (aggravated), G1 = 1 (stationary), G2 = 2 (improved), G3 = 3 (much improved), G4 = 4 (no residual symptom).
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Fig 4. A 68-year-old female patient with chronic pain of the anterior aspect of the right leg and a tingling sensation in the L4 dermatome. MR imaging (not shown) showed degenerative spondylolisthesis at the L3/4 level with foraminal stenosis. There was no pain relief in follow-up of 2 weeks after a conventional transforaminal epidural steroid injection (TFESI) at the L3 level.
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Fig 5. A 26-year-old female patient with acute onset radiculopathy in the L3 dermatome. A left paracentral disk protrusion was observed at the L3/4 level in MR images (not shown). A lateral fluoroscopic view showing the needle tip positioned in the posterior aspect of the neural foramen and contrast filling into the posterolateral epidural space. The patient had no pain 2 weeks after posterolateral TFESI of L3.
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