Lumbar Transforaminal Epidural Steroid Injection | Live Demonstration | by Dr Debjyoti Dutta

A lumbar transforaminal epidural steroid injection (LTESI) is a procedure that can help relieve chronic and severe pain in the lower back and legs caused by certain conditions that affect the spinal nerves. The procedure involves injecting a steroid medication into the epidural space, which is the area around the spinal cord and nerve roots, through a small needle. The steroid can reduce inflammation and irritation of the nerve roots, which can improve pain and function.

The lumbar spine is the lower part of the spine that consists of five vertebrae (L1 to L5) and supports the weight and movement of the upper body. The spinal cord runs through a canal in the center of the vertebrae and branches off into nerve roots that exit through openings called foramina. These nerve roots carry signals between the brain and the rest of the body.

Sometimes, the nerve roots can become compressed or inflamed by various conditions, such as herniated discs, spinal stenosis, spondylolisthesis, bone spurs, or arthritis. This can cause pain, numbness, tingling, or weakness in the lower back and legs, which is called lumbar radiculopathy or sciatica.

An LTESI can help treat lumbar radiculopathy by delivering the steroid medication directly to the affected nerve root through the foramen. The medication can reduce swelling and inflammation of the nerve root and ease pressure on it. This can relieve pain and improve mobility and quality of life.

An LTESI is usually done as an outpatient procedure under local anesthesia and fluoroscopic guidance. Fluoroscopy is a type of X-ray that allows the doctor to see the needle position and ensure accurate placement of the medication. The doctor will ask the patient to lie face down on a table with a cushion under their stomach to create more space for the needle. The doctor will then clean and numb the skin over the injection site and insert a thin needle through the skin and into the epidural space near the affected nerve root. The doctor will inject a contrast dye to confirm the correct location of the needle and then inject the steroid medication. The needle will be removed and a bandage will be applied to the injection site.

The procedure usually takes about 15 to 30 minutes and has minimal risks and side effects. Some common side effects include temporary pain, bleeding, bruising, or infection at the injection site, headache, nausea, flushing, or dizziness. Rare but serious complications include nerve damage, spinal cord injury, paralysis, allergic reaction, or infection in the epidural space.

An LTESI can provide pain relief for several weeks to months, depending on the individual response and condition. However, it is not a cure for the underlying cause of lumbar radiculopathy and should be combined with other treatments such as physical therapy, exercise, medication, or surgery if needed. An LTESI may be repeated up to three times a year if necessary.

An LTESI is a safe and effective treatment option for patients with chronic and severe lower back and leg pain due to lumbar radiculopathy. It can help reduce inflammation and irritation of the spinal nerve roots and improve function and quality of life.