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Safe Injectate Choice, Visualization, and Delivery for Lumbar Transforaminal Epidural Steroid Injections: Evolving Literature and Considerations

  • Musculoskeletal Rehabilitation (B Schneider, Section Editor)
  • Published:
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Abstract

Purpose of Review

Lumbar transforaminal epidural steroid injection (TFESI) is a widely used treatment for lumbar radicular pain refractory to conservative care. However, rare but serious risks exist. This article summarizes the recent literature regarding considerations relevant to safe performance of TFESIs.

Recent Findings

We collated recent case report reporting of permanent neurologic injury after TFESI, which has been theorized to occur as a result of disrupted radiculomedullary arterial blood flow to the spinal cord. We also review how injectate selection, visualization methods, and delivery techniques may impact the safety considerations of these injections.

Summary

While TFESIs are safe, there is continued need to optimize injectate selection, visualization methods, and delivery techniques to minimize the possibility of complications while maintaining clinical effectiveness.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA

    Patricia Zheng

  2. Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN, USA

    Byron J. Schneider & David J Kennedy

  3. Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, USA

    Zachary L. McCormick

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  1. Patricia Zheng
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  2. Byron J. Schneider
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Correspondence to Zachary L. McCormick.

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Zheng, P., Schneider, B.J., Kennedy, D.J. et al. Safe Injectate Choice, Visualization, and Delivery for Lumbar Transforaminal Epidural Steroid Injections: Evolving Literature and Considerations. Curr Phys Med Rehabil Rep 7, 414–421 (2019). https://doi.org/10.1007/s40141-019-00244-5

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