Transforaminal Epidural Injection and Selective Nerve Root Block

Transforaminal Epidural Injections are considered the most specific and effective route for epidurals and are administered laterally through the selected neuroforamen under fluoroscopy, thus explaining the description "Selective Transforaminal Epidural Injection."

Selective Nerve Root Blocks are performed under fluoroscopic guidance; a needle is inserted into the foraminal space at the suspected spinal level and then anesthetic medication is injected. It is used as a diagnostic tool; because of the numbing medicine’s “blockage” of the nerve being tested pinpoints the source of pain. If the patient’s symptoms improve at the time of the procedure, then the “blocked” nerve root is likely the culprit source of the patient’s symptoms.

Procedure Summary

The skin area is cleaned and sterilized. A local anesthetic is injected under the skin and given time to numb the skin and spine muscles. A fluoroscope, which is a type of video x-ray, is positioned over the patient. The physician uses fluoroscopy as they place a needle of their choice into the neck or back; the nerve root exits the spinal canal through a small bony opening created between the vertebrae called a foramen. In the case of a transforaminal epidural injection, an anesthetic and corticosteroid combination is injected into the foraminal space. A corticosteroid is a powerful, slow-releasing, anti-inflammatory medication. The steroid and anesthetic mixture is injected into the area bathing the nerve root. If a patient's pain improves following the injection, then inflammation irritating that nerve root is the likely the source of the pain and has been quelled with the medicine. Otherwise, a reversible inflammatory process involving the suspected nerve root is unlikely the source of the person’s pain.

A selective nerve root block is performed for diagnostic reasons only. The procedure is similar to the transforaminal epidural injection, except that the physician injects only the anesthetic or numbing medicine. Like when the dentist numbs the nerves to a tooth, the selected spinal nerve root is numbed or “blocked” and if the clinical symptoms are immediately but transiently improved, then this nerve root is the source of the pain. If there is no relief from the block, then this nerve root is unlikely to be the pain source.

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