Safe Injectate Choice, Visualization, and Delivery for Lumbar Transforaminal Epidural Steroid Injections: Evolving Literature and Considerations

  • Patricia Zheng
  • Byron J. Schneider
  • David J Kennedy
  • Zachary L. McCormickEmail author
Musculoskeletal Rehabilitation (B Schneider, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Musculoskeletal Rehabilitation


Purpose of Review

Lumbar transforaminal epidural steroid injection (TFESI) is a widely used treatment for lumbar radicular pain refractory to conservative care. However, rare but serious risks exist. This article summarizes the recent literature regarding considerations relevant to safe performance of TFESIs.

Recent Findings

We collated recent case report reporting of permanent neurologic injury after TFESI, which has been theorized to occur as a result of disrupted radiculomedullary arterial blood flow to the spinal cord. We also review how injectate selection, visualization methods, and delivery techniques may impact the safety considerations of these injections.


While TFESIs are safe, there is continued need to optimize injectate selection, visualization methods, and delivery techniques to minimize the possibility of complications while maintaining clinical effectiveness.


Epidural injections Safety Injectate Visualization Transforaminal Steroids 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Patricia Zheng
    • 1
  • Byron J. Schneider
    • 2
  • David J Kennedy
    • 2
  • Zachary L. McCormick
    • 3
    Email author
  1. 1.Department of Orthopaedic SurgeryUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of Physical Medicine and RehabilitationVanderbilt UniversityNashvilleUSA
  3. 3.Division of Physical Medicine and RehabilitationUniversity of Utah School of MedicineSalt Lake CityUSA

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