Ultrasound-Guided Lumbar Transforaminal Epidural Injection: A Narrative Review

Abstract

Transforaminal epidural steroid injection is often administered to patients with radiculopathy under fluoroscopic guidance, although it has disadvantages of radiation hazards and requirement of a special area to perform the block. To avoid these disadvantages, ultrasound-guided transforaminal injection (USTFI) has recently been described and is continually developed. This review article describes the indexed articles published on USTFI and ultrasound-guided selective nerve block (SNRB) to evaluate current evidence on best approach to perform the block. Through literature search, eight articles and one case report on USTFI and five articles on ultrasoundguided SNRB were found. Most of the studies have utilized parasagittal orientation of curvilinear probe to perform the block. Nevertheless, with the present literature, it is difficult to come to any conclusion. Further studies with larger sample size and description of dye spread patterns are recommended to come to a more definite conclusion.

Ultrasound and nerve stimulator guidance lumbar transforaminal epidural block for the treatment of patients with lumbosacral radicular pain

“…Moreover, in previous studies, authors have explored both axial and parasagittal approaches for US-guided TEB. Recently, some authors used the parasagittal approach because of better vision and easier to perform the block, especially in the upper spine and older patients 6 , 19 , 20 . Moreover, most of the authors performed US-guided TEB in in-plane needle trajectory in both approaches because of needle path visualization.…”

“…Gofeld et al described a technique that placed the needle tip on the vertebral body instead of the desired space in the foraminal area 21 . All previous studies on US-guided TEB have used another standard method (fluoroscopy or CT) to confirm needle tip position because of the limited vision of the needle tip at the foraminal area due to the bony structure of the lumbar spine 6 , 22 . We used axial approach and in-plane needle trajectory for UNTEB and confirmed needle tip position by fluoroscopy before injection of medications.…”

“…To visualization of the needle tip and navigation to the target point during the TEB, this procedure is performed under the fluoroscopy or computed tomography (CT) 4 . Many writers have sought to explain US-guided TEBbecause of the benefits of US-guided nerve block, and they have had a lot of success in the treatment of lumbar radicular pain 5 , 6 . Based on previous studies, fluoroscopy is the most reliable method for appropriate positioning of the needle during the TEB, but this manner cannot stablish the exact relation with clinical symptoms 6 .…”

“…Many writers have sought to explain US-guided TEBbecause of the benefits of US-guided nerve block, and they have had a lot of success in the treatment of lumbar radicular pain 5 , 6 . Based on previous studies, fluoroscopy is the most reliable method for appropriate positioning of the needle during the TEB, but this manner cannot stablish the exact relation with clinical symptoms 6 . Electrical stimulation of the nerve root, especially a motor response at low amplitude, can cause symptoms of radicular pain during US-guided TEB; therefore, identify the proper level involved with radicular pain 7 .…”

The Role of Power Doppler Ultrasonography in Caudal Epidural Injection

“…In such patients, more studies should be conducted to prove the feasibility of PDU-assisted CEI. Third, this study was conducted only on CEI; however, ultrasonography has been useful for other epidural injection techniques, such as transforaminal injection [ 30 , 31 , 32 ]. The application of PDU during transforaminal epidural injection requires more large-scale and cautious studies to prove its feasibility and safety.…”