Thoracic and lumbar transforaminal epidural steroid injections

Facet joints in the thoracic spine and the lumbar spine are alternatively referred to as zygapophyseal or apophyseal joints. Because they oppose the neural elements, degeneration and hypertrophy may cause compression of spinal roots, the spinal cord, and the thecal sac of the lumbar spine. Each joint is composed of the superior articular process of the caudal vertebra and the inferior articular process of the rostral vertebra. The opposing surfaces are covered with synovium, while the outer surface is covered by fibrous capsule. The joints of the thoracic spine from the C7-T1 joint to the T9-10 joint are typically oriented in the coronal plane and assume a configuration not unlike that of shingles on a roof. The T10-11 joint is often a transition area where the joint orientation becomes slightly tangential to the coronal plane. The portion of the joint that is visible dorsally in the lumbar spine is mostly composed of the inferior articular process of the rostral vertebra; this is readily demonstrated with removal of the joint capsule. The superior articular process of the inferior vertebra forms the ventral and lateral portion of the joint. Because of its location directly adjacent to the exit point of the nerve root laterally and the thecal sac medially, the superior facet process often comprises the point of maximal compression when joint hypertrophy leads to neural compromise. Because innervation of the facets themselves is via medial branches of the dorsal primary rami, degeneration of the facets may produce back pain by this mechanism. 2 – 4

Thoracic and lumbar transforaminal epidural steroid injections

thoracic and lumbar transforaminal epidural steroid injections

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