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A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations
Published on: August 7, 2018
Lumbar Disc Features Predictive of Favorable Response to Transforaminal Epidural Steroid Injection: a Comprehensive
Alexander Kervyn De Volkaersbeke1, Sudeep Peddireddy2, Gabriel Howard2
1Temple University, 3401 N. Broad St., Philadelphia, PA, 19140, USA. kervyn.a@gmail.com.
Current Pain and Headache Reports
|July 20, 2026
Summary
Transforaminal epidural steroid injections (TFESI) for lumbar disc herniation (LDH) show variable outcomes. Lateral herniations and mild nerve compression may improve TFESI success, but technique and clinical predictors are key.
Area of Science:
- Pain Management
- Neurosurgery
- Radiology
Background:
- Lumbar disc herniation (LDH) is a common cause of radicular pain.
- Transforaminal epidural steroid injections (TFESI) are frequently used for pain management.
- Predictive factors for TFESI success in LDH, especially herniation location, require further clarification.
Purpose of the Study:
- To review the impact of lumbar disc herniation (LDH) location on the efficacy of transforaminal epidural steroid injections (TFESI).
- To identify other clinical and imaging predictors influencing TFESI outcomes for radicular pain management.
- To hypothesize that more lateral herniations correlate with better TFESI treatment responses.
Main Methods:
- Systematic review of 13 studies on TFESI outcomes for patients with lumbar disc herniation (LDH).
- Analysis included studies assessing disc morphology, herniation location (central, paracentral, foraminal, extraforaminal), and nerve root compression.
- Outcome measures comprised Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and other pain/disability indices.
Main Results:
- Some studies indicated better TFESI outcomes for lateral herniations (foraminal, extraforaminal), while others found no significant difference based on location.
- Two studies suggested superior outcomes for central herniations.
- Mild nerve compression, a positive Slump test, and optimal TFESI technique were associated with favorable results, whereas severe compression and technical difficulties with lateral herniations were detrimental.
Conclusions:
- Lumbar disc herniation (LDH) location can influence transforaminal epidural steroid injections (TFESI) response, with lateral herniations and mild compression generally associated with positive outcomes.
- Clinical predictors like a positive Slump test and procedural technique may be more critical to TFESI success than herniation location alone.
- Further standardized research is necessary to optimize patient selection and understand prognostic factors for TFESI treatment response in lumbar disc herniation (LDH).
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