Preganglionic Epidural Steroid Injection through Translateral Recess Approach

Area of Science:

• Neurosurgery
• Pain Management
• Spinal Anatomy

Background:

• Lumbar degenerative disc disease can affect spinal nerves, leading to radiculopathy.
• Retrodiscal transforaminal epidural injection is effective for lumbar radiculopathy but faces anatomical challenges below L5.
• The L5-S1 region presents specific anatomical restrictions for traditional epidural injection techniques.

Observation:

• The translateral recess approach (TLR) was developed to overcome anatomical limitations in the L5-S1 region.
• TLR allows precise needle placement in the axillary portion between nerve roots without causing neural injury.
• This technique utilizes the wide interlaminar space at L5-S1 for superior and lateral needle trajectory.

Findings:

• Preganglionic epidural injection via TLR provides effective access to the primary pathology in lumbosacral radiculopathy.
• The TLR technique ensures accurate needle positioning, avoiding damage to the exiting and traversing nerve roots.
• Successful preganglionic epidural injections were achieved using the TLR method in the L5-S1 region.

Implications:

• TLR represents a safe and effective spinal intervention for managing lumbosacral radiculopathy.
• This approach expands treatment options for patients with degenerative disc disease affecting lower spinal nerves.
• The TLR technique may improve outcomes for patients experiencing radicular pain due to L5-S1 pathology.