An epidural steroid injection is a pain management technique that can help you find relief from chronic neck, radicular pain, or back pain. A transforaminal epidural steroid injection refers to how the needles are placed during the procedure. These injections can help you reduce pain, increase your mobility, and avoid or delay the need for surgery. In this post, we’ve gathered information from leading healthcare practices around the web to help you learn more about this procedure.
What is a transforaminal epidural steroid injection?
Epidural steroid injections are injections into an affected area with a steroid medication and, at times, an anesthetic. This is done to reduce inflammation in the area, and may also help to reduce pain through the release of endorphins. The following video gives an in-depth view of how this procedure takes place.
- Transforaminal injections
- Caudal injections
- Interlaminar injections
The interlaminar method is the most popularly-used method for this treatment. It involves placing the medication-delivering needle between two vertebrae, allowing for drug delivery to nerves on both sides of the spinal column.
With a transforaminal approach, the doctor inserts the needle at an angle relative to the vertebra into the epidural space that is where a nerve root exits. As Ohio Health explains:
“This opening is known as a foramen. There is a small sleeve of the epidural space that extends out over the nerve root for a short distance. This epidural root sleeve is just outside the spinal canal.”
Unlike an interlaminar approach, a transforaminal injection only targets one side of the spine. This is the best approach for patients who have surgical pins, rods, or bone grafts from previous surgeries. A transforaminal epidural steroid injection can be used to reduce pain, but it can also be used as a diagnostic technique to identify a specific spinal nerve root level that is leading to a person’s pain.
How does a transforaminal epidural steroid injection procedure take place?
This procedure is an out-patient procedure that typically only takes five to ten minutes for the actual injection to take place. You will have a local anesthetic applied before the procedure, but you won’t be completely out during it. It’s especially important for you to be awake and present during the procedure if you’re using it for a diagnostic reason.
A transforaminal epidural steroid technique can be done in the lower back region or the neck region. These are called, respectively:
- Lumbar transforaminal epidural steroid injection
- Cervical transforaminal epidural steroid injection
The following video from New Jersey Spine & Rehabilitation shows how this procedure is performed.
How can transforaminal injections diagnose pain?
As the Beth Israel Deaconess Medical Center explains:
“Epidural steroid injections are useful in both the diagnosis and treatment of certain spine conditions. By placing the medication in a precise area and monitoring the patient’s response, valuable information is gained about what nerves may or may not be involved in causing the symptoms, and how to target appropriate treatment for pain relief.”
What conditions are treated with this procedure?
A transforaminal epidural steroid injection may help treat pain in the neck, back, arms, or legs. As Mayfield Brain & Spine reports, it can benefit pain conditions associated with:
- Disc herniation
- Spinal stenosis
- Degenerative disc disease
Ohio Health, however, gives a great explanation of how this procedure may affect you:
“It is sometimes difficult to predict if the injection will help you or not. Patients who have pain radiating from the spine down into the arms or legs respond better to the injections than the patients who have only pure neck or back pain. Similarly, the patients with a recent onset of pain may respond much better than patients with longstanding pain.”
While transforaminal epidural steroid injections can be a very effective treatment for many patients, your pain doctor will be the best guide on how this treatment could work for you. Make sure to review the information in this post, and bring any more questions with you to your appointment with your doctor.
Are transforaminal epidural steroid injections safe?
Epidural steroid injections are considered to be largely safe, and are used often in the treatment of pain.
Transforaminal epidural steroid injections, in particular, may require more guidance from imaging as the doctor performs the procedure, as the needle must be inserted into empty space to the side of the spinal column. However, this approach is regarded as being comparable to the specificity needed for the interlaminar approach. Transforaminal injections may also be associated with reduced risks of dural damage. Some research even indicates that this approach may be superior in cases of spinal pain associated with neuropathy in comparison to the caudal or interlaminar approach.
How many transforaminal epidural steroid injections are safe?
The number depends for each patient, but generally pain doctors recommend a series of only two or three injections over a one to two month period. Capitol Pain Institute explains how injections are administered after this initial period:
“If the injections are successful, most patients will experience at least 6 months of pain relief after the initial series of injections. You may return for future injections when the pain returns. Future injections are given as single injections (not a series) and can be happen as often as every four weeks if necessary, however, most patients do not require follow-up injections more often that every three months.”
What to expect after a transforaminal epidural steroid injection?
After the injection, you will experience some pain and numbness. You must also get a ride home due to the sedation. The North American Spine Society discusses what you can expect after you receive a transforaminal injection:
“The steroid will usually begin working within 1-3 days, but in some cases it can take up to a week to feel the benefits. Although uncommon, some patients will experience an increase in their usual pain for several days following the procedure. The steroids are generally very well tolerated, however, some patients may experience side effects.”
Even though pain relief may take a few days, you can generally return to normal activities the day after your procedure.
What are transforaminal epidural steroid injection side effects?
Transforaminal epidural steroid injection side effects may include:
- Steroid flush, a flushing of the face and chest that can last several days, general feeling of warmth, or even a low-grade fever
- Changes in menstrual cycle
- Sleep issues or insomnia
- Elevated blood sugar
- Bleeding or infection at the injection site
Most side effects will be mild and should resolve within a few days. Discuss these with your doctor if you have any specific concerns about this procedure.
Can I expect pain after a transforaminal epidural steroid injection?
You may experience slight pain, swelling, or tenderness at the injection site following your procedure. Northwestern Medicine reports:
“Initially, you may experience numbness and/or relief from your symptoms for up to six hours after the injection. When the anesthetic wears off, your usual symptoms may return. The steroids usually require three to five days to provide pain relief.”
Are there transforaminal epidural steroid injection complications or risk factors?
As Spine Universe explains:
“Complications are rare but may include headaches, infections, blood pressure changes, bleeding, and discomfort at needle insertion site. Use of steroids rarely causes an increase in blood sugar and blood pressure, as well as leg swelling. The major complication, that being damage to a nerve root is very rare. However, using a blunt needle may even more reduce the risk of this complication.”
Risk factors may include:
- An allergy to iodine or contrast dyes
- Taking some medications (always discuss your current medications with your doctor)
- Any other serious medical conditions
River Cities Interventional Pain Specialists explains why diabetics have to be careful, noting:
“Diabetic patients will need to monitor their blood sugar before and after the procedure as steroid can cause blood sugar to rise. As long as a diabetic patient’s blood sugar is normal before the procedure and monitored after the procedure, the risk of a dangerously high blood sugar is low.”
Where can I learn more about transforaminal epidural steroid injections?
You can see more about this procedure in the videos on this page, or watch the transforaminal epidural steroid injection video provided by the Methodist Health System on their website.
- The Lumbar Transforaminal Epidural Steroid Injections Review and Recommendation Statement from the North American Spine Society
- A systematic review of the treatment for lumbar pain published in Pain Physician
- Spine-Health’s review of studies related to transforaminal epidural steroid injections
- A comparison between the transforaminal and interlaminar techniques from the American Academy of Pain Medicine
- Our greater list of research on our epidural steroid injections page on PainDoctor.com
To find out more about transforaminal epidural steroid injections, talk to a pain doctor today in your area. They can help you learn more about this pain treatment option.