Transforaminal ESI level question

[MustangGtV894]

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Question - for a Right sided L4-5 posterolateral disc herniation with L5 nerve impingement would you guys inject at L4-5 (L5 traverses) or L5-S1 (L5 exits)?

 

[mid|ine]

Personally I would do an LESI unless TFESI is indicted by prior surgery.

But to answer your question i would do L4-5 if only 1 level (assuming its the traversing L5 nerve root you are discussing). If failed, consider L5-S1. I also think a 2 level would be appropriate.

 

[Laryngospasm]

I’m going to piss some people off and say L4 and L5.

 

[callmeanesthesia]

I’d do both.

 

[MitchLevi]

Either one is fine, don’t do both levels as a first injection. I would do L4-5 ILESI or TFESI, if that doesn’t work do the two level TFESI.

 

[Dr. Ice]

I’m going to piss some people off and say L4 and L5.

Or L5 and S1..follow the flow..goes up and down

 

[SSdoc33]

Right L5 TFESI

 

[DOctorJay]

If it looks like the L5 nerve root is being irritated I'd start with an L5-S1 TFESI and consider adding the L4-5 level as well if needed for subsequent procedure.

 

[pmrmd]

R L5-S1 TFESI is the place to start. Gotta cover the DRG.