• Jui-Hsuan Liu, Cheng-Wei Soo, Ying-Chun Lin, and Chia-Shiang Lin.
• Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan.
• Pain Pract. 2021 Nov 1; 21 (8): 978-983.

IntroductionTransforaminal epidural steroid injection (TFESI) is one of the nonoperative interventions for lower back pain. In this study, we presented an alternative approach for TFESI, far lateral lateral recess TFESI (FLLR TFESI), which is targeted on lateral recess and anterior epidural space in patients with degenerative lumbar spondylosis-related radiculopathy.TechniqueUnder fluoroscopy, needle entry site and pathway are drawn according to the spinal anatomy. The needle is advanced toward the lateral recess and the needle tip is placed medially to the medial border of the pedicle under anteroposterior view and posteriorly to the posterior border of the upper endplate under lateral view. After checking optimal contrast spread, steroids and local anesthetics are injected.Case IllustrationAn 86-year-old woman who suffered from lower back pain with radiculopathy received interventional treatment. Comparing the "traditional" supraneural approach with the FLLR approach, the difference in contrast enhancement to lateral recess is clearly shown.DiscussionCompared to the pre-existing approaches, the FLLR approach may provide better ventral epidural and lateral recess enhancement. Furthermore, with the advanced needle tip, the injectate may enhance not only the at-level nerve root but also the nerve root of adjacent level during their existence in a single injection. With blunt needle usage, no nerve root injury or dura puncture was noted so far.ConclusionFLLR TFESI is a modified fluoroscopic technique targeted on lateral recess and anterior epidural space. However, subsequent trials are needed to confirm its efficacy in pain reduction and the rate of complications.© 2021 World Institute of Pain.

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