Practice Patterns of Physicians Who Perform Lumbar Transforaminal Epidural Steroid Injections

Area of Science:

• Pain Management
• Interventional Radiology
• Neurosurgery

Background:

• Lumbar transforaminal epidural steroid injections (TFESIs) are a cornerstone treatment for lumbosacral radicular pain.
• The transforaminal approach offers precise corticosteroid delivery to the epidural space and nerve root, aiding in inflammation reduction and functional improvement.
• This technique is valuable for patients with prior laminectomy or contraindications to interlaminar approaches.

Purpose of the Study:

• To review current practice patterns and technical preferences of interventional pain physicians performing lumbar TFESIs.
• To document procedural experiences, including fluoroscopic guidance, injection levels, and the occurrence of paresthesia.

Main Methods:

• A survey was distributed to interventional pain physicians (academic, hospital-based, private practice) via email, web links, and social media.
• Survey questions focused on fluoroscopic views, single vs. two-level injections, and paresthesia frequency during lumbar TFESIs.
• Anonymous data were collected and analyzed using descriptive statistics from 87 respondents.

Main Results:

• 60.9% of physicians preferred a combination of AP, oblique, and lateral views for fluoroscopic guidance.
• 63.2% sometimes performed two-level injections, 27.6% always did, and 9.2% exclusively performed one-level injections.
• Paresthesia occurred sometimes in 73.6% of cases, most of the time in 18.4%, and never in 6.9%.

Conclusions:

• Significant diversity exists in practice patterns for lumbar TFESIs among interventional pain physicians.
• Most physicians favor multi-view fluoroscopic guidance and tailor the number of injection levels to clinical necessity.
• Paresthesia is a common but variable occurrence during TFESIs, underscoring the need for further research into best practices and patient outcomes.