A transforaminal epidural steroid injection is a medical procedure designed to alleviate pain and inflammation in the spine. This targeted injection delivers medication directly to specific spinal nerves. Its primary aim is to reduce discomfort, especially pain that radiates from the spine to other body parts like the arms, legs, or feet. It serves as a non-surgical option for managing pain.
Understanding the Injection
The term “transforaminal” refers to the path the needle takes through a small opening in the side of the spine called the foramen, where spinal nerves exit the spinal canal. The term “epidural” denotes the epidural space, an area surrounding the spinal cord and nerve roots. This space lies between the dura mater, the outermost protective membrane of the spinal cord, and the bony vertebral canal.
The injection contains a corticosteroid, an anti-inflammatory medication, often combined with a local anesthetic. The local anesthetic provides immediate, temporary pain relief by numbing the nerve. The corticosteroid reduces inflammation and swelling around affected nerve roots. It does this by inhibiting inflammatory chemicals and reducing immune activity, which lessens pressure on compressed nerves and alleviates pain.
Conditions Addressed
Transforaminal epidural steroid injections address pain from nerve root compression and inflammation in the spine. When a nerve root is compressed or irritated, it can lead to radiating pain, numbness, tingling, or weakness. This type of pain, called radiculopathy, can occur in the neck (cervical radiculopathy) or lower back (lumbar radiculopathy or sciatica).
Common conditions causing nerve compression treated with these injections include herniated discs and spinal stenosis. A herniated disc occurs when a spinal disc’s inner material pushes through its outer layer, pressing on nerve roots. Spinal stenosis involves a narrowing of the spinal canal or nerve exits, leading to pressure on the spinal cord or nerves. These injections reduce inflammation at the source, relieving pain, numbness, and tingling.
The Procedure Explained
Before the procedure, patients typically lie on their stomach on an X-ray table. The provider cleans the injection site with an antiseptic solution and may administer a local anesthetic to numb the skin and underlying tissues. Some patients may also receive intravenous sedation to help them relax, though they usually remain awake and able to communicate.
The procedure uses fluoroscopy, real-time X-ray imaging, to precisely guide a thin needle to the targeted nerve root as it exits the spine through the foramen. To confirm accurate needle placement, a small amount of contrast dye is injected, which can be seen spreading around the nerve root on the fluoroscopy screen. Once proper positioning is verified, the mixture of corticosteroid and local anesthetic is injected into the epidural space. The entire injection process typically takes about 10 to 15 minutes.
What to Expect
Preparation involves discussing current medications, especially blood thinners, which may need to be stopped a few days prior. Patients are usually advised to have a light meal before the procedure and may need a ride home, especially if sedation is used.
Immediately after the injection, patients are monitored for a short period, typically 30 to 60 minutes. It is common to experience temporary numbness or weakness in the affected limb due to the local anesthetic, which usually subsides within a few hours. Some individuals might notice increased pain or soreness at the injection site for a day or two, which can be managed with ice.
The pain-relieving effects of the steroid medication do not typically appear immediately, often taking 24 to 72 hours to begin working, with full effects potentially seen after about a week. Pain relief from the steroid can vary in duration, ranging from a few weeks to several months. Healthcare providers may recommend a series of injections, often up to three or four per year, depending on the patient’s response. Patients are generally advised to take it easy for the remainder of the day and can often resume normal activities the following day. It is important to communicate any concerns or unexpected symptoms with the healthcare provider.