Practice Patterns of Physicians Who Perform Lumbar Transforaminal Epidural Steroid Injections

Abstract

Purpose of review: Lumbar transforaminal epidural steroid injections (TFESIs) are a widely used interventional procedure for managing lumbosacral radicular pain and other spinal conditions. TFESIs help reduce inflammation and enhance function by delivering corticosteroids into the nerve root and epidural space. The transforaminal approach is commonly utilized for its precise targeting, offering both diagnostic and therapeutic benefits. Furthermore, this technique can be performed in patients with a history of laminectomy or contraindications to performing an interlaminar approach at the targeted levels. This study reviews current practice patterns, technical preferences, and procedural experiences of interventional pain physicians performing lumbar TFESIs.

Recent findings: A survey was distributed to interventional pain physicians via email, web links, and social media platforms. Respondents included academic physicians in ACGME-accredited fellowship programs, as well as hospital-based and private practice physicians. The survey contained questions focusing on fluoroscopic views used for TFESIs, frequency of one-level versus two-level injections, and the occurrence of paresthesias during lumbar TFESIs. Data were collected anonymously, and descriptive statistics were used to analyze responses. A total of 87 respondents completed the survey. For fluoroscopic guidance, 60.9% (53/87) preferred using a combination of AP, oblique, and lateral views. Regarding injection levels, 63.2% (55/87) reported sometimes performing two-level injections, while 27.6% (24/87) always performed two levels, and 9.2% (8/87) exclusively performed one-level injections. The frequency of paresthesia during TFESIs varied, with 73.6% (64/87) reporting paresthesia occurring sometimes, 18.4% (16/87) reporting it most of the time, and 6.9% (6/87) stating it never occurred. This study highlights diverse practice patterns among interventional pain physicians performing lumbar TFESIs. Most physicians prefer multi-view fluoroscopic guidance and adapt the number of injection levels based on clinical need. Paresthesia during TFESIs is commonly reported but varies in frequency. These findings provide preliminary insights into procedural techniques and decision-making in lumbar TFESIs, offering a foundation for future research to refine best practices and improve patient outcomes.

Keywords: Chronic pain; Epidural steroid injection; Fluoroscopic guidance; Pain management; Pain medicine; Practice patterns; Transforaminal epidural steroid injection.