A transforaminal injection is an injection of long acting steroid into the opening at the side of the spine where a nerve roots exits. 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. Sometimes these injections are referred to as root sleeve blocks, root blocks or transforaminal epidural blocks. The long acting steroid that is injected reduces the inflammation and swelling of spinal nerve roots and other tissues surrounding the spinal nerve root. This may in turn reduce pain, tingling and numbness and other symptoms caused by such inflammation, irritation or swelling. Also, the transforaminal injections can be used to identify a specific spinal nerve root level or levels that are the source of pain.
A transforaminal epidural steroid injection is helpful in several circumstances for back pain and lower back pain. First, if a disc has herniated in the lumbar region (resulting in lower back pain), an epidural injection could be helpful in decreasing inflammation and allowing the disc to heal. This treatment can also be used in degenerative disc disease where the height of the disc is affected and nerves are compressed. Those who have lumbar spinal stenosis also can achieve pain relief from an injection, and compression fractures of the lumbar vertebrae respond well to this treatment.
1) Cervical: A cervical transforaminal epidural steroid injection is an outpatient procedure for treating neck, upper back, shoulder, and arm pain. If you have pain in your neck or upper back when you move your head or neck, you may have cervical disc and dural inflammation. If pain travels to your arm when you move your head or neck, you may have nerve root inflammation.
2) Lumbar: A lumbar transforaminal epidural steroid injection is an outpatient procedure for treating low back and leg pain. If you have pain in your low back when you bend your back, you may have lumbar disc or dural inflammation. If pain travels to your leg when you move your back, you may have nerve root inflammation.
3) Thoracic: A thoracic transforaminal epidural steroid injection is an outpatient procedure for treating upper or mid back pain. If you have pain in your upper back when you move, you may have thoracic disc or dural inflammation. If pain travels to the front of your chest when you move your upper or mid back, you may have nerve root inflammation.
Pain that radiates from your neck into your arm(s) or pain that radiates from your low back into your leg(s).
The foramen refers to the opening in between the vertebrae and at the side of the spine where a nerve root exits. Through such procedure as a lumbar transforaminal epidural steroid injection, this specific area of the epidural space is targeted and injected with anti-inflammatory medication.
The procedure in focus can have both therapeutic and diagnostic purposes. For the latter, the steroid injection alongside the anesthetic medication could help determine the cause of the symptoms of the pain in the lower back and pain that radiates from the lumbar spine to the legs. Moreover, it could also help determine whether the foramen is indeed the cause of pain. For therapeutic purposes, this procedure has a higher likelihood of success in reducing inflammation and swelling of irritated spinal nerves because the medication is delivered directly into the neural foramen that contains the actual nerve. Precision is key in an injection such as this, which is why this procedure ensures a more focused approach on the correct nerve.
It is done either with the patient on the side for most neck injections and with the patient on the stomach for back injections. Occasionally other positions are used to optimize the X-ray view. All patients receiving sedation are monitored with EKG, blood pressure cuff and oxygen monitoring device. Patients not receiving sedation are monitored if needed. The skin of the neck or back is cleaned with antiseptic solution and sometimes numbed with local anesthetic. Then the injection needle is placed under X-ray guidance. Once in place, the injection is made and this will often feel like the normal pain that the patient feels in the distribution of that spinal nerve root. Finally, the needle is removed and an adhesive bandage is applied.
You may initially feel worse for 2 to 3 days following the injection due to irritation of the medication near the nerve or from the steroid itself. You should begin feeling pain relief within a few days.
Although epidural steroid injections are largely effective, their effects can wear off after a period. You may need to have this procedure performed again and up to 3 to 6 times per year, if symptoms persist. Transforaminal Epidural steroid injections can reduce sciatica pain by almost 90%. Patients report feeling less pain, greater mobility, and increased quality of life. With relatively few side effects, epidural steroid injections are a viable treatment option.
Transforaminal injections are generally safe and are done routinely without any complications. However, as with any procedure there are risks, side effects and possibility of complications. The most common side effect is pain from the actual injection once the local anesthetic wears off and this pain is temporary. The other uncommon risk involves spinal puncture with headaches, infection, bleeding inside the epidural space, nerve damage and worsening of symptoms. Other uncommon risks are related to the side effects of the long acting steroid such as weight gain, increase in blood sugar in diabetics, water retention and suppression of body’s own natural production of steroids.
Learn more on how to procedure is done