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Injection through the nerve root opening (foramen) represents an alternative to injection directly into the epidural space across the lamina or via the caudal canal. This is known both as a transforaminal injection or a selective nerve root block. The injection through the nerve foramen places the needle tip and the medicine into the anterior (front) of the epidural space, close to where the sinuvertebral nerves enter the disc. Since these nerves transmit pain from degenerated discs, injecting near them can often help pain that is resistant to translaminar injection.
On occasion, the interventional pain physician will slip a tiny catheter through the needle into the spinal or epidural space. The catheter can often be directed closer to the source of pain, allowing the medicines to be more effective. Similarly, the catheter can be used to try to break up tiny scars (adhesions) that tug on nerve-sensitive structures. This is called "Adhesiolysis" meaning "breaking apart of adhesions" and is sometimes referred to as the "Racz Procedure."
In cases where previous surgery inhibits epidural or transforaminal injection, the interventional pain physician may approach the epidural space through the lowest opening to the space, called the "caudal" canal.
Some injections can be done on nerves far away from the spinal area, such as the greater occipital nerve (used to treat some headaches in the back of the head), the lateral femoral cutaneous nerve (used to treat some types of leg pain), or on digital nerves (used to block fingers or toes).
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