Transforaminal Epidural Steroid Injection

What is a transforaminal epidural steroid injection?

A transforaminal epidural steroid injection can reduce spinal pain and inflammation. It can also ease pain that radiates from your spine to other areas like your arms, legs and feet.

Here are some details about your spine to help you understand how transforaminal epidural steroid injections work:

• Transforaminal: Through the foramina. Foramina are openings where your nerves exit your spinal canal and extend to other areas of your body.
• Epidural: On or around the dura mater. The dura mater is a thick membrane that surrounds your spinal cord.

So, a transforaminal epidural steroid injection involves placing a needle through the foramen (opening) in your spine and injecting steroid medications around the space that protects it. This isn’t an injection into your spinal cord or into your nerves, but rather into a safe space around them.

Unlike other epidural steroid injection techniques, the transforaminal approach requires X-ray guidance (fluoroscopy) for higher precision. X-ray images make it easier for providers to locate and target specific spinal nerves.

Healthcare providers use transforaminal epidural steroid injections to treat:

• Lower back pain.
• Sciatica.
• Spinal stenosis.
• Foraminal stenosis.
• Herniated disk.
• Spinal compression (causing a pinched nerve).
• Spondylolysis.
• Spondylolisthesis.
• Scoliosis.
• Bone spurs.
• Spinal nerve damage.

Types of transforaminal epidural steroid injections

You might hear healthcare providers use slightly different names when referring to these injections, including lumbar, cervical or thoracic transforaminal epidural steroid injections. These names refer to the section of your spine that requires treatment. For example:

• Lumbar transforaminal epidural steroid injections treat nerves in your lower back. When inflamed, these nerves can cause lower back pain or radiating leg pain.
• Thoracic transforaminal epidural steroid injections treat nerves in the middle portion of your back. When inflamed, these nerves can cause middle back pain or radiating chest or belly pain.
• Cervical transforaminal epidural steroid injections treat nerves in your neck and the upper portion of your spine. When inflamed, these nerves can cause neck pain, radiating shoulder and arm pain, or hand pain.

What happens during a transforaminal epidural steroid injection?

You’ll lie on your stomach on an X-ray table. Before beginning your procedure, your provider will give you an injection of local anesthesia to numb your skin. You may feel a slight burning or pinching sensation. Your provider can also give you IV (intravenous sedation, through your vein) to increase your comfort level. Sedation may make you feel sleepy, but you’ll remain awake and be able to communicate with your healthcare provider. (Ask your provider about sedation options during your initial consultation.)

Once you’re comfortable, your provider will begin the procedure. Using fluoroscopy for guidance, they’ll:

• Insert a long, thin needle into your back, targeting the specific nerve root causing your pain.
• Inject a mixture of anesthetic (for temporary pain relief) and steroid medications (for longer-term relief).

The entire procedure usually takes about 30 minutes.

What happens after my appointment?

You can continue your regular diet and medications right away. Take it easy, don’t drive for 12 hours and steer clear of vigorous exercise. You can return to your normal activities the next day.

It may take 24 to 48 hours for the steroid to start taking effect, and it may take up to two weeks to reach the peak effect. If you don’t feel better within 14 days, see your provider to discuss alternative treatments.

How long does a transforaminal epidural steroid injection last?

Pain relief following a transforaminal epidural steroid injection can last several weeks to several months. The timeframe varies from person to person. If this treatment works, you can have periodic injections to keep symptoms at bay.

How often can you get a transforaminal epidural steroid injection?

In general, it’s safe to have three to six transforaminal epidural steroid injections per year. Some people need fewer, others may need more. The more injections you have, the more likely you are to develop side effects.

If you don’t feel improvement after two or three injections, it’s unlikely that more injections will help. Your healthcare provider is the best person to tell you how often you can safely receive this treatment, or if you may need to consider alternative treatments.

What are the side effects of a transforaminal epidural steroid injection?

The risk of complications from this type of injection is very low. Rarely, complications include bleeding, infection or nerve injury at the injection site. Transforaminal epidural steroid injection side effects may include:

• Numbness or weakness in your legs or feet.
• Dizziness.
• Headache.

These side effects usually go away within a few hours.

When should I call my healthcare provider?

Following your transforaminal epidural steroid injection, you should call your healthcare provider if:

• Numbness, weakness or other side effects linger for more than a day.
• You have new pain that you didn’t have before your procedure.
• Your existing pain gets worse.
• You develop signs of infection like fever, swelling or increasing warmth and redness around the injection site.

How painful is a transforaminal epidural steroid injection?

Most people report feeling pressure or a pinching sensation while the provider places the needle and injects the medication. Local anesthesia should prevent you from feeling pain or severe discomfort.

What is the difference between an epidural and a transforaminal epidural?

Healthcare providers use two techniques to give epidural steroid injections: interlaminar and transforaminal. The main difference is how (and where) the provider places the needle.

• Interlaminar injection: During this procedure, a provider inserts the needle through your interlaminar window — a bony opening near the middle of your spine. Healthcare providers typically use X-ray guidance for this injection.
• Transforaminal injection: Instead of placing the needle through your interlaminar window, your provider will locate the foramen (opening) that’s closest to the affected nerve and place the needle there. Providers always use X-ray guidance when doing transforaminal injections.

A note from Cleveland Clinic

Transforaminal epidural steroid injections work by treating inflammation at its source — your nerve roots. If you have sciatica, herniated disks, chronic back pain or other related conditions, this treatment could significantly improve your quality of life. Talk to your healthcare provider to find out if transforaminal injections are right for you.