Transforaminal Epidural Steroid Injection

What is a Transforaminal Epidural Steroid Injection?

An epidural spinal injection or epidural block is a non-surgical treatment option for relieving back pain and other symptoms.

Epidural steroid injections contain a strong anti-inflammatory agent (steroid) and an anaesthetic for pain relief. It is administered into the epidural space of the spine, the space between the outermost covering of the spinal cord (dura mater) and the wall of the spinal canal. The epidural space is approximately 5 mm wide and is filled with spinal nerve roots, fat tissue and small blood vessels.

An epidural steroid injection may be administered through a transforaminal approach where the injection needle is placed into the opening or foramen, on the side of the vertebra, through which the spinal nerve roots pass. The transforaminal approach is preferred to other methods as it delivers the medication more precisely to the target nerve.

Indications for Transforaminal Epidural Steroid Injections

Spine degenerative conditions such as herniated disc, spinal stenosis and many others may induce back pain due to compression of the associated spinal nerves. The pain or numbness may extend to other parts of your body such as the hips, buttocks and legs. Your doctor first recommends non-surgical methods to treat back pain. Epidural blocks are one of these preferences.

An epidural spinal injection may be employed both for diagnostic and therapeutic reasons.

• Diagnostic: Helps determine the specific nerve root involved in the spinal problem
• Therapeutic: Induces short or long-term relief from pain and inflammation

Goal of Transforaminal Epidural Steroid Injection

Epidural spinal injections are not curative interventions but reduce discomfort so that rehabilitation programs such as physical therapy may be well executed. If no relief is obtained from an epidural block or other non-surgical methods, surgery may be recommended.

Preparing for a Transforaminal Epidural Steroid Injection

Your doctor will review your medical history thoroughly before the procedure. You may be asked to undergo an imaging test to help your doctor plan for the treatment. Your doctor may advice you to stop taking blood thinning medications 3 to 5 days before an ESI. You will be advised to eat a light meal before the treatment.

How are Transforaminal Epidural Steroid Injections Administered?

Transforaminal epidural blocks are usually administered on an outpatient basis. The procedure involves the following steps:  

• You will be taken to the pre-op area where trained nursing staff check your vitals, review your medications and prepare you for the procedure. Blood sugar and coagulation status may also be evaluated if needed.
• You are then taken to the procedure room and will lie face down on a table.
• The injection site is cleaned and a local numbing agent administered so that you don’t feel pain during the procedure.
• A thin hollow needle is then inserted into the epidural space through the neural foramen at the side of the vertebra, guided by fluoroscopy, which provides real-time X-ray images of the needle’s position on a monitor for your surgeon to view.
• A contrast material is then injected through the properly placed hollow needle to confirm drug flow to the affected nerve.
• When your doctor is satisfied with the position of the needle, the anesthetic drug and corticosteroid are injected through the same needle inserted in the spine.
• Finally, the needle is removed and the injection site covered with a dry, sterile bandage.

The procedure takes about 15-30 minutes to complete. You may feel some pressure during the injection, but the procedure is mostly painless.

Post-procedure Instructions for a Transforaminal Epidural Steroid Injection

You will be monitored for a short while after the procedure. You are then encouraged to walk around. You may experience mild discomfort at the site of injection. Soreness in and around the injection site can be relieved by using ice packs. You will be advised to resume your normal activity on the next day. You may have to go to visit your doctor for a follow-up a week after the procedure.

You should not drive or return to work immediately after the procedure. You should rest and avoid any vigorous activities. Your doctor may provide specific post-care instructions. Please follow the instructions for a faster recovery.

Pain Relief Following Transforaminal Epidural Steroid Injections

You will feel numbness in the arms or legs just after the procedure due to the anaesthetic component. This usually wears off within 1-8 hours, following which you may feel some back pain. The steroid component of the epidural block takes about 24-72 hours before you can experience its pain-relieving action.

In some cases, if the desired effect is not obtained, reinjection may be recommended. The standard guidelines for steroid injections state a maximum of 3 injections per year. In case relief is not obtained from the spinal injection, then surgery is considered.

Risks and Complications Associated with Transforaminal Epidural Steroid Injections

As with any procedure, epidural blocks may be associated with certain complications such as:

• Bleeding or infection at the injection site
• Pain during or after injection
• Post-injection headache
• Nerve injury
• Bladder dysfunction
• Fluid retention
• Respiratory arrest
• Epidural hematoma
• Spinal cord infarction

Discuss with your doctor if you have any concerns prior to the procedure.