Radicular Pain Treatments
Transforaminal Epidural Steroid Injection vs. Selective Nerve Root Block
Both transforaminal epidural steroid injections and selective nerve root blocks address radicular pain. Radicular pain is a result of inflammation/irritation of a nerve that originates from the spinal cord and provides sensation to the arms or legs. This pain is often described as numbness, burning, tingling, or shooting pain. This is also often referred to as neuropathic pain. The differences between transforaminal epidural steroid injections and selective nerve root blocks are minor, however, they do serve different diagnostic purposes and are used to guide patient treatment plans.
The term transforaminal epidural steroid injection describes an injection with the needle tip that resides within the intervertebral foramen. Epidural steroid injections are therapeutic injections. These injections are performed by placing a small spinal needle under x-ray guidance into the epidural space close to the problem area and then injecting x-ray contrast dye to confirm optimal flow. Once the correct needle placement is confirmed then a mixture consisting of a steroid and a local anesthetic is injected into the epidural space. This is the space just behind the nerves, spinal fluid, and spinal cord. This mixture is useful to reduce inflammation, swelling, numbness, and pain from inflamed nerve roots or herniated discs. It is also helpful in treating spinal stenosis.
Transforaminal Epidural Steroid Injection
The term selective nerve root block typically describes an injection adjacent to the spinal nerve root, with the needle tip remaining outside of the intervertebral foramen. The injection is similar to a transforaminal epidural steroid injection, but in a selective nerve root block there is no attempt to have the medication enter the epidural space. Rather, the aim is strictly to cover the offending nerve root and block the nerve for approximately 4 hours. This is important in differentiating from transforaminal epidural steroid injections because they guide the physician in the diagnosis of the nerve root that is the cause of the radicular pain. By doing so, this can also guide the surgeon towards the appropriate levels that will require surgical intervention. These are often used more for diagnostic purposes although they can alleviate radicular pain.