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Excerpt
I thank Drs. Datta and Pai for their interest in my article.1 I would still recommend using the term “transforaminal epidural steroid injection” for the therapeutic injection and the term “selective spinal nerve block” for the diagnostic injection.
In Figs 4 and 5 of my article, dye is indeed seen to have spread into the epidural space, which I believe is instructive to the reader. However, it is not the dye that causes neuronal blockade. Watching the pattern of dye spread during “real-time” fluoroscopy can identify possible pathology and can help predict what volume of subsequent local anesthetic is likely to stay localized to the nerve root.
The prefix trans is derived from Latin and means across, beyond, through.2 During a therapeutic transforaminal epidural steroid injection, although the needle does not traverse the entire foramen, the subsequent therapeutic injection of local anesthetic and steroid does pass through the foramen. This type of discussion is very useful in helping us to be more precise when describing injection techniques, and I welcome such debate and evaluation of terminology.
