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Background and Aims Epidural injection of corticosteroids and local anesthetics is an important therapeutic option for managing lumbar radicular pain. Ultrasound alone isn’t suitable for transforaminal epidural injections (TFESIs) due to limited visualization of structures beneath the bone. Integrating ultrasound and fluoroscopy offers advantages like reduced radiation exposure, soft tissue visualization. This study aims to determine the impact of integrating ultrasound guidance into TFESIs on radiation dose and procedure time.

Methods This prospective randomized study included 55 patients aged 18-70 with lumbar radiculopathy due to disc herniation and unresponsive to conservative treatment, planned for single-level TFESIs. Group F received fluoroscopy-guided TFESIs, while Group H received ultrasound-fluoroscopy integration. In Group H, after advancing the needle under ultrasound guidance to the lateral edge of the target vertebra, the procedure proceeded with fluoroscopic imaging. In both groups, the same solutions were administered into the epidural space. Demographic data, radiation dose, radiation duration, procedure duration, number of fluoroscopy shots, complications, contrast spread pattern, and Numeric Rating Scale (NRS) scores were recorded and compared.

Results Statistical analysis was completed with 50 patients after excluding 5 patients who started with ultrasound guidance. Group F (n=25) showed statistically significantly higher radiation dose (p=0.001; p < 0.01), radiation duration (p < 0.01), fluoroscopy shots (p < 0.01), and supranuclear rate (p < 0.01) than Group H (n=25). No significant differences were found in procedure duration, complication rate (p>0.05), or NRS scores before and after the procedure (p>0.05).

Conclusions Integrating ultrasound guidance into TFESIs as a hybrid method reduces both radiation exposure and duration.