Transforaminal Epidural Steroid Injections
An epidural steroid injection deposits steroid medication into a general area of lumbar (lower back) or cervical (neck) spine. A "transforaminal epidural steroid injection" can be thought of as a specific type of epidural injection designed instead to selectively deposit medication at 1 or 2 specific nerve roots in the spine. "Nerve roots" are the large nerves that come out of the spine, right and left, at each spinal level. Occasionally the nerve roots become inflamed and irritated through pressure exerted on them by conditions such as tissue injury, herniated discs, spinal stenosis, arthritis or bone spurs. Often the inflammation of these nerve roots can be lessened and sometimes even eliminated by the injection of strong anti-inflammatory drugs called steroids into the space occupied by the nerve root as it leaves the spinal canal. This space is located just to the side of the sac which contains your spinal cord and is called the "neural foramen." Each spinal level has both a right and a left neural foramen to correspond with the right and left nerve root, and an injection here is called a "transforaminal epidural steroid injection." Whether a regular epidural steroid injection or a transforaminal injection is best for you is a decision made on a case by case basis depending on your specific history and symptoms, in consultation with your referring physician. Since this is a type of epidural steroid injection, the information presented here is very similar (with the exception of the description of the procedure) to that in the "Epidural Steroid Injection" handout also found on my website.
How is the procedure performed?
First, with you positioned on your belly, I use local anesthetic to desensitize the skin over your spine at the level of your inflamed nerve. Then, using x-ray guidance to be certain that the needle is in the correct location, I place a needle into the specific neural foramen thought to be the site of your problem, and it is here that I inject the steroid along with a small amount of local anesthetic. The desired result is a decrease in the inflammation of the affected nerve with, hopefully, substantial relief of your pain over the following 7 to 14 days. The procedure usually takes less than 30 minutes. In most cases I will give you a sedative to lessen the discomfort of inserting the needle, but as the needle is positioned you may occasionally experience a pressure sensation or a transient pain similar to your usual nerve root symptoms as the steroid solution is injected. Additionally, some patients may notice a transient increase in discomfort for a few days after the injection.
What is the benefit of this injection?
The benefit of transforaminal epidural steroid injection is the potential for the lessening or elimination of your nerve root pain. Over half of the patients who have an injection report 50% to 75% pain relief, but both the quantity and quality of the pain relief you will obtain are unpredictable in advance. Some patients experience 100% relief while others notice no improvement at all. The duration of your relief is variable as well, ranging from those who note no improvement to those who never have pain again. This injection, however, is a reasonable treatment option for you when conventional treatment such as pain medicines, bed rest, exercises and physical therapy have failed to give relief, and when one would like to avoid surgery, if possible.
Your physician will refer you for the injection, and will inform me of your age, presumed diagnosis, and results of any pertinent tests which may have been done, such as MRI or CT scans. Once this information is received my office will call you to schedule the procedure with you. We will go through your history and the details of the procedure, as well as answer any questions that you may have at the surgery center before proceeding. Please be patient if you are not called immediately. Every effort, however, will be made to schedule your injection at the earliest and most convenient time for both of us.
Because some patients can feel faint during the procedure it is preferred that you not eat or drink anything for four hours prior to your injection. Most medications, however, should be taken as prescribed with small sips of water, though you should let me know if you are on blood thinners such as warfarin, coumadin, Ticlid, Eliquis, Plavix or aspirin, because often these medications must be stopped for up to a week before the procedure.
What are the potential problems?
As with any medical procedure, transforaminal epidural steroid injections do have the potential for side effects or complications. As already mentioned, you may not obtain any relief or your symptoms may worsen for a few days after the injection. Less commonly seen than after a regular epidural steroid injection is spinal tap, which may result in your procedure being postponed, plus the possibility of a spinal headache. This headache can range from mild to incapacitating. The primary treatment is bed rest and pain medicines, but if your headache is severe and lasts more than a few days, another procedure can be carried out which usually eliminates the headache very rapidly. The more serious, but very rare complications include nerve paralysis, infection of the spine, or causing bleeding which could compromise a nerve root. Serious complications such as these are very rare, and probably occur with a frequency no higher than 1 in 6000. When I talk with you we will have a more full discussion of the risks and benefits of this procedure, taking into account your specific medical history.
What should I expect after the injection?
You will be expected to have a ride home following the procedure. Most patients will be able to resume normal activities almost immediately after the injection, but as stated above, some patients may have increased nerve root pain following the injection. These patients are advised to rest in a comfortable position for a day or so, and continuation of prescribed pain medicines remains appropriate as needed for post-injection pain.
Follow-up visits to your referring physician after your injection vary. At a minimum, you should call your referring physician 10 to 14 days following your injection to discuss your experience with the block. Since the injection takes a week or two to take maximal effect, I will usually wait until then to follow-up with you by phone.
All of your physicians hope your nerve root pain will resolve without surgery, and a transforaminal epidural steroid injection is one treatment option that may help you obtain this goal.
Please click on the link below to be redirected to the website drdillin.com to see a video animation of this procedure