FIGURE LEGENDS FOR SUPPLEMENTARY FIGURES
Supplementary Figure 1: Patient B a: Sagittal MRI of lumbar spine MRI showing lumbar
disk herniation with severe left and moderate right neuroforaminal stenosis at the L5-S1 level
and diffuse disc bulges at L1-L2, L2-L3, L3-L4 and L4-L5 levels. b: Axial MRI of L5-S1 level
showing narrowing of the right intervertebral foramen with abutment against the exiting right L5
nerve root and facet joint hypertrophy. c: TFESI at the L5-S1 level, left-sided. Left lateral
flouroscopic view; contrast spreading into the intervertebral disc. d: TFESI at the L5-S1 level,
left-sided. Anterior-posterior view; contrast spreading into the intervertebral disc.
Supplementary Figure 2: Patient C a: Sagittal MRI of lumbar spine showing multi-level discosteophyte complexes, spinal fusion hardware and a disc bulge at L2-L3. b: Axial MRI of L2-L3
level showing cortical thinning of lamina, post-surgical changes and narrowing of the right
neural foramen. c: TFESI at the L2-L3 level, right-sided. Lateral fluoroscopic image depicting
contrast along the nerve root, as well as in the disc space. d: TFESI at the L2-L3 level, rightsided. Anterior-posterior fluoroscopic image of contrast along nerve root and also intradiscal.
Supplementary Figure 3 Patient D a: Sagittal MRI of lumbar spine showing a mild
straightening of lumbar lordosis, and a mild-moderate disc protrusion at L3-L4 and L5-S1.
b: Axial MRI of L4–L5 level showing laminectomy changes, a broad-based central disc
protrusion, facet joint hypertrophy and patent neural foramina. c: LESI at the level L4-L5, rightsided. Lateral fluoroscopic image showing contrast spreading in the epidural space, as well as in
the intervertebral disc. d: TFESI at the level L4-L5, right-sided. Same patient as depicted above
in Suppl. Fig. 3-a, subsequent pain clinic visit. Anterior-posterior fluoroscopic image shows
contrast along the left L5 nerve root, as well as in the disc space.
Supplementary Figure 4: Patient E a: Para-sagittal MRI of lumbar spine showing disc bulges
at L1-L2, L4-L5 and L5-S1; anterolisthesis of L4-L5 and severe neuroforaminal stenosis. b:
Axial MRI of L4–L5 level showing post-surgical changes, a mild central disc bulge and severe
facet arthropathy. c: TFESI at the L4-L5 level, right-sided. Image demonstrates an epidural
spread of 0.5mL of the contrast. d: TFESI at the L4-L5 level, right-sided. Image demonstrates
an epidural and intradiscal spread of 1.0mL of the contrast.
Supplementary Figure 5: Patient F a: Sagittal MRI of lumbar spine showing a right
paracentral disc extrusion directed superiorly behind the L2 vertebral body with compression of
the exiting right L2 nerve and traversing right L3 nerve. There was mild central canal stenosis
with severe right neural foraminal stenosis and a prominent disc bulge at L4-L5 and also smaller
bulge at the L5-S1 level. b: Patient F: Axial MRI of L2–L3 level showing centrally protruding
disc material. c: Patient F: TFESI at the L2-L3 level, right-sided. Anterior-posterior
fluoroscopic image reveals additional contrast intradiscally. d: Patient F: TFESI at the L2-L3
level, right-sided. Lateral fluoroscopic image shows intradiscal contrast with needle tip recessed
away from the disc space.