{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:10:58Z","timestamp":1787242258623,"version":"build-2736575974"},"reference-count":60,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Anatomy"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Transforaminal epidural steroid injections (TFESIs) are frequently used to treat lumbar and radicular pain. Although ischemic complications are extremely rare, their severity\u2014often resulting in irreversible paraplegia\u2014necessitates a thorough understanding of the anatomical and procedural risk factors. This review carefully examines the vascular anatomy of the lumbar intervertebral foramen, the distribution and risks associated with radiculomedullary arteries, and reported cases of severe complications related to lumbar TFESIs. Anatomical and radiological data indicate that radicular arteries are particularly rare below the L2\u2013L3 level and are more common on the left side. The upper third of the intervertebral foramen, especially at T12\u2013L3, is the most likely site of arterial involvement, raising concerns about the safety of traditional subpedicular approaches. Kambin's triangle appears to be a safer alternative, reducing arterial contact while still enabling effective drug delivery. The use of particulate corticosteroids, especially methylprednisolone and triamcinolone, is strongly associated with ischemic events owing to their larger particle sizes. Non\u2010particulate options such as dexamethasone are preferred, particularly at higher spinal levels. Although rare, venous punctures and hematomas require vigilance and careful steroid selection. Test doses of local anesthetics remain controversial and do not provide clear protective benefits. Current evidence indicates that adjusting techniques\u2014including needle placement, imaging guidance, and corticosteroid choice\u2014can help reduce risks while maintaining the effectiveness of lumbar TFESIs.<\/jats:p>","DOI":"10.1002\/ca.70102","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T16:02:12Z","timestamp":1772985732000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Understanding Vascular Risks in Lumbar Transforaminal Epidural Injections: Insights From Anatomy and Clinical Evidence"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0363-8037","authenticated-orcid":false,"given":"Martin","family":"Avellanal","sequence":"first","affiliation":[{"name":"Pain Clinic Hospital Universitario La Moraleja  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1977-7034","authenticated-orcid":false,"given":"Irene","family":"Riquelme","sequence":"additional","affiliation":[{"name":"Pain Clinic Hospital Universitario La Moraleja  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Ferreiro","sequence":"additional","affiliation":[{"name":"CUHMED, School of Medicine, Madrid, and Department of Radiology Madrid University Hospital  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2664-2277","authenticated-orcid":false,"given":"Francisco","family":"Reina","sequence":"additional","affiliation":[{"name":"Grupo de Investigaci\u00f3n en Anatom\u00eda Cl\u00ednica, Embriolog\u00eda y Neurociencias (NEOMA), Human Anatomy Unit, Facultat of Medicine Universidad de Girona  Girona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3265-2778","authenticated-orcid":false,"given":"Anna","family":"Carrera","sequence":"additional","affiliation":[{"name":"Grupo de Investigaci\u00f3n en Anatom\u00eda Cl\u00ednica, Embriolog\u00eda y Neurociencias (NEOMA), Human Anatomy Unit, Facultat of Medicine Universidad de Girona  Girona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1317-1047","authenticated-orcid":false,"given":"R. Shane","family":"Tubbs","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tulane Center for Clinical Neurosciences Tulane University School of Medicine  New Orleans Louisiana USA"},{"name":"Department of Anatomical Sciences St. George's University  St. George's West Indies"},{"name":"Department of Structural and Cellular Biology Tulane University School of Medicine  New Orleans Louisiana USA"},{"name":"Department of Neurosurgery and Ochsner Neuroscience Institute Ochsner Health System  New Orleans Louisiana USA"},{"name":"Department of Neurology Tulane University School of Medicine  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1221-1214","authenticated-orcid":false,"given":"Andr\u00e9 P.","family":"Boezaart","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University of Florida College of Medicine  Gainesville Florida USA"},{"name":"Lumina Health  Surrey UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9078-1020","authenticated-orcid":false,"given":"Miguel A.","family":"Reina","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University of Florida College of Medicine  Gainesville Florida USA"},{"name":"CEU\u2010San Pablo University, School of Medicine, Madrid, and Department of Anesthesiology Madrid\u2010Montepr\u00edncipe University Hospital  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.36076\/ppj\/2019.22.89"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542\u2010200702000\u201000022"},{"key":"e_1_2_10_4_1","first-page":"86","volume-title":"Practice Guidelines for Spinal Diagnostic and Treatment Procedures","author":"Bogduk N.","year":"2004"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg\u20102021\u2010018160"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/apmr.2000.7166"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11916\u2010020\u201000900\u20109"},{"key":"e_1_2_10_8_1","first-page":"515","article-title":"Digital Subtraction Angiography Does Not Reliably Prevent Paraplegia Associated With Lumbar Transforaminal Epidural Steroid Injection","volume":"15","author":"Chang\u2010Chien G. 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