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

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.