I'd agree with the safer part. No way in hell do you get better anterior spread than a TFESI! How can you get better anterior spread than if your needle is already in the anterior epidural space? Looking at those pictures I though the anterior flow was superior with TFESI.
I do agree that you can get decent anterior spread with far lateral ILESI. And it's still more target specific than a caudal......
Even though I'm a big proponent of lumbar TFESI, I do worry enough about arterial uptake with TFESI, even at lower levels, that my first lumbar ESI on someone is usually a far lateral ILESI (with particulate steroid) to the side of pathology. Many patients do great with far lateral ILESI, if not, they get a TFESI.
I'm finding this approach all the more applicable recently, now with some prominent ISIS board members suggesting doing all levels of TFESI with dex and the fluoro code removed for TFESI.
I think you get more sustained effect doing a far lateral ILESI with particulate steroid compared to TFESI with dex, and it's easier, faster, safer, and(with flouro)now reimburses very similar to TFESI.