What Is a Transforaminal Epidural Steroid Injection?

There are many pain conditions caused by irritation of the nerves that exit the spine. When inflammation or other conditions compress the nerves, it can result in radiculopathy symptoms. One diagnostic or treatment option is a transforaminal epidural steroid injection.

Spine injections are an effective way to determine the source of pain and often provide relief. There are different types of spinal injection treatments, many using steroid medications. The type of injection is determined by where on the spine it is used, the medications and how the injection is performed.

What Is an Epidural Steroid Injection?

Epidural steroid injections usually include a corticosteroid medication combined with an anesthetic or numbing medication. These injections are delivered to the epidural space around the nerve roots exiting the spine. The different types of epidural steroid injections are defined by the following:

• Spine location – cervical (neck), thoracic (upper back) and lumbar (lower back)
• Caudal delivery – into the coccyx
• Interlaminar delivery – between the vertebrae
• Transforaminal delivery – through the foramen on one side of the spine

A lumbar transforaminal epidural steroid injection is placed in the lower spine and enters through the right or left foramen. This can be a more effective option for some patients than interlaminar epidural steroid injections, angling into the boney sheath where the nerve exits the spine.

Benefits of Epidural Steroid Injection

There are many conditions that can benefit from epidural steroid injections. When injected into the epidural space, the anesthetic can numb the nerve temporarily, which can provide immediate pain relief. The steroid can also relieve inflammation and pain, but the effects take a few days to work.

Your doctor may suggest an epidural steroid injection for a few different reasons. If you are having neck, back or radiating pain, the injection can help in diagnosing your condition. The anesthetic and steroid can help identify which nerves are affected to aid in creating an effective treatment plan.

For others, epidural steroid injections can provide pain relief. If pain is caused by nerve irritation, the steroid injection may provide temporary or permanent relief from symptoms. Some of the conditions that may respond to an epidural steroid injection include:

• Bulging, slipped or herniated spinal discs
• Spinal stenosis
• Sciatica
• Degenerative disc disease
• Spondylolysis

For those with lower back pain or sciatica symptoms, a lumbar transforaminal epidural steroid injection may be helpful for diagnosis or treatment. The transforaminal injection method is specifically useful for sciatica, which usually only affects one side of the body.

How Big Is the Epidural Needle?

Many people are concerned about receiving a transforaminal epidural steroid injection. It is common for patients to ask their doctor, “How big is the epidural needle?”, “How long does an epidural last?” or “Will the injection hurt?” The epidural needle can vary in size, depending on where the injection is placed and other factors.

Most epidural needles range from 3-5 inches long and gauges (width) from 14 to 25, but 22 is a common gauge for epidural needles. The injection is usually very well tolerated by most patients; the doctor or nurse will numb the area first before the injection is performed.

How Long Does an Epidural Last?

When a transforaminal epidural steroid injection is performed, patients may experience immediate effects. The numbing medication in the injection can affect the nerve causing pain or other symptoms. Patients may be asked to walk or move to see if the injection has numbed the correct nerve in the spine.

The initial numbing effect of the anesthetic will dissipate in a few hours and the original pain may return. The steroid takes a few days for the anti-inflammatory effects to be noticeable. Depending on the spine condition, patients may or may not get pain or symptoms relief from the steroid.

If the steroid does provide pain relief, the effects can last from a few weeks to several months or longer. In some cases, the source of nerve irritation dissipates and once the steroid wears off, the symptoms are gone. For others, the symptoms can return after a week or two, requiring a different treatment option.

Risks of Epidural Steroid Injections

Like most medical procedures, epidural steroid injections do have some risks. Your doctor will discuss any possible side effects from your treatment and what to expect after your injection. The most common side effects are injection site tenderness, bruising and swelling. However, more serious risks can include:

• Severe headache
• Temporary bladder control issues
• Infection
• Weakened muscles (most doctors will limit these injections to 2-3 times a year)
• Nerve damage

While there are risks, epidural steroid injections are commonly performed, and serious complications are rare.

If you have lower back pain or sciatica, your doctor may recommend a transforaminal epidural steroid injection for diagnosis or treatment of your condition. Your doctor can answer any questions you may have and whether this treatment could provide you with relief.

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