Lumbar Epidural Injection

Abstract

Lumbar transforaminal injection is an intervention to deliver a certain amount of steroids combined with local anesthetic to the so-called dorsal root ganglion in the neuroforamen. There is rigorous evidence for laboratory evaluation of inflammatory processes at the nerve root. Since steroids can suppress inflammation here, intervention is logical. The transforaminal approach offers the possibility to deliver the necessary medication in the maximum concentration directly to the site of pathology. Moreover, with a small amount of local anesthetic alone, a diagnostic statement can be made. For example, this is one way to preoperatively identify the affected nerve root when imaging is inconclusive. The dorsal epidural space in particular can be accessed via the interlaminar approach. In a so-called intervention in the lateral recessus, it is possible to infiltrate several nerve roots. Indications for lumbar transforaminal and interlaminar injection are: (1) a radicular pain is proven anamnestically, clinically and possibly also with electrophysiological findings, (2) a non-response to conservative treatment with appropriate medication, physical measures and physiotherapy.