The Lumbar Neural Foramen and Transforaminal Epidural Steroid Injections: An Anatomic Review With Key Safety Considerations in Planning the Percutaneous Approach

AJR Am J Roentgenol. 2017 Jul;209(1):W26-W35. doi: 10.2214/AJR.16.17471. Epub 2017 May 15.


Objective: The purpose of this article is to review the anatomy of the lumbar neural foramen and to describe techniques of transforaminal epidural steroid injections with emphasis on safety. Rare cases of paraplegia have been reported.

Conclusion: Although no consensus currently exists about which approach is the safest, knowledge of the foraminal anatomy is a key consideration when choosing a needle approach for transforaminal epidural steroid injections.

Keywords: epidural steroid injection; lumbar neural foramen; radiculopathy; spine.

Publication types

  • Review

MeSH terms

  • Epidural Space / anatomy & histology*
  • Humans
  • Injections, Epidural / methods*
  • Lumbar Vertebrae / anatomy & histology*
  • Needles
  • Patient Safety*
  • Radiculopathy / drug therapy*
  • Steroids / administration & dosage*


  • Steroids