Bilateral L5-S1 Transforaminal
Epidural Steroid Injections
These procedures are usually done with fluoroscopy in a dedicated room or operating suite. Fluoroscopy or x-ray guidance is necessary to insure proper placement of the needle and medications. Some of these procedures offer diagnostic value as well as potential therapeutic value. When properly selected, these procedures may reveal a correctible source of pain that has been overlooked. Common procedures include selective transforaminal epidural injections, facet joint injections, medial branch blocks and sacroiliac joint injections. Others, such as, caudal epidurals or interlaminar injections are more generalized but offer significant therapeutic value in well-chosen patients. All have significant risks.
These procedures are performed close to neural structures and often in highly vascular areas. Bleeding, infection, and embolization can all ultimately lead to paralysis or death after needle trauma. In addition, there are potential side effects from the injected medications. These include glucose intolerance potentially unmasking diabetes or worsening blood sugars, and, fluid accumulation or reactivation of latent infection from the steroids. The carrier fluid, typically lidocaine, can cause complete anesthesia temporarily leading to limb weakness and falls, or, bowel and bladder incontinence. If taken up in the bloodstream lidocaine can also cause respiratory depression and other complications. Despite these potential ill effects, these procedures can abolish acute pain or restore chronic pain to a tolerable baseline after a flare that is unresponsive to oral medications and other treatments.
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