An update on technical and safety practice patterns in transforaminal epidural steroid injections

Area of Science:

• Interventional Pain Management
• Spinal Injections
• Medical Practice Trends

Background:

• Transforaminal epidural steroid injections (TFESIs) are common pain management procedures.
• Previous studies indicate variability in TFESI practice patterns.
• Published safety guidance exists for TFESIs.

Purpose of the Study:

• To assess recent trends in periprocedural safety practices for TFESIs.
• To investigate the influence of the COVID-19 pandemic on interventional pain practices.
• To understand the impact of supply chain shortages on TFESI procedures.

Main Methods:

• A cross-sectional survey was conducted from March 2021 to March 2022.
• The survey targeted pain management fellowship directors and private practice interventional pain physicians.
• Data on TFESI practices were collected and analyzed from 103 complete responses.

Main Results:

• 102 physicians perform TFESIs across cervical, thoracic, lumbar, and sacral regions.
• Significant variability exists in preprocedural imaging review, sedation, contrast, fluoroscopy, and steroid choices.
• Many physicians reported a decrease in weekly procedures due to the COVID-19 pandemic.

Conclusions:

• Practice variability in TFESI periprocedural aspects persists despite safety recommendations.
• Further research is needed to identify barriers to guideline adherence.
• Recent trends influenced by the COVID-19 pandemic and supply chain issues warrant consideration for future disaster preparedness.