Lumbar Transforaminal Injection of Steroids
Lumbar transforaminal injection (TFI) of corticosteroids is a procedure whereby an aliquot of a given corticosteroid preparation is delivered into the immediate vicinity of a lumbar spinal nerve and its respective roots, by way of the corresponding intervertebral foramen. The procedure is designed as a treatment for lumbar radicular pain.
The first description of the “epidural” injection of corticosteroid was via the transforaminal route (Robecchi and Capra 1952). This became the standard route of administration in the 1950s and 1960s, but was superseded by the caudal and interlaminar routes in the United States and in Britain in the 1960s and later in Europe and Scandinavia. These latter routes became the standard for common practice.
In the late 1900s, the beginning of a reversion to the transforaminal route was prompted by a number of factors. These include, among others, reviews suggesting that caudal and...
- Bogduk, N., Aprill, C., & Derby, R. (1995a). Selective nerve root blocks. In D. J. Wilson (Ed.), Interventional radiology of the musculoskeletal system (pp. 121–132). London: Edward Arnold. Ch 10.Google Scholar
- Bogduk, N., Aprill, C., & Derby, R. (1995b). Epidural steroids. In A. D. White (Ed.), Spine care, vol 1: Diagnosis and conservative treatment (pp. 322–343). St Louis: Mosby. Ch 22.Google Scholar
- International Spinal Intervention Society. (2004). Lumbar transforaminal injection of corticosteroids. In N. Bogduk (Ed.), Practice guidelines for spinal diagnostic and treatment procedures. San Francisco: International Spinal Intervention Society.Google Scholar
- Kang, J. D., Georgescu, H. I., McIntyre, L., et al. (1995). Herniated lumbar intervertebral discs make neutral metalloproteinases, nitric oxide, and interleukin-6. Orthopaedic Transaction, 19, 53.Google Scholar
- Riew, K. D., Yin, Y., Gilula, L., Bridwell, K. H., Lenke, L. G., Lauryssen, C., & Goette, K. (2000). The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. Journal of Bone and Joint Surgery, 82A, 1589–1593.Google Scholar
- Robecchi, A., & Capra, R. (1952). L'idrocortisone (composto F). Prime esperienze cliniche in campo reumatologico. Minerva Medica, 98, 1259–1263.Google Scholar
- Weiner, B. K., & Fraser, R. (1997). Foraminal injection for lateral lumbar disc herniation. Journal of Bone and Joint Surgery, 79B, 804–807.Google Scholar