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Transforaminal Injection: After your skin is anesthetized, the needle enters through the side of the vertebra above the opening for the exiting nerve root. This approach treats one side at a time and is thought to be more specific. Pain specialists who are treating patients who have undergone previous spine surgery and have foreign bodies (surgical pins, surgical rods, or screws) as well as previous scarring prefer this method because they are able to avoid these structures. There is powerful evidence suggesting that transforaminal ESIs are effective for short-term and moderate for long-term improvement in managing lumbar back pain (Manchikanti 2007).
Caudal Injection: After your skin is anesthetized, a needle enters the epidural space by your tailbone. This technique allows for a catheter to be placed (Racz catheter) and larger volumes of steroid and anesthetic to be delivered. The additional medication can be used to affect more nerve roots distributing to the inflamed area at the same time. Often caudal ESIs are combined with another procedure called lysis of adhesions or the Racz Procedure, which is used to treat epidural scaring. The evidence for caudal ESIs is similar to that of the transformational ESIs.