What is a Transforaminal Epidural Steroid Injection?
Epidural refers to the space in your spine that surrounds your spinal fluid and spinal cord. The epidural space is a space that can operate as a reservoir to deposit medication to help reduce pain. A transforaminal injection deposits a steroid into the opening at the side of the spine where a nerve roots exits. This opening is known as a foramen. Sometimes these injections are called root sleeve blocks, root blocks, or transforaminal epidural blocks. The goal of this procedure is to deposit a powerful anti-inflammatory medication close to the source of your spine pain. Also transforaminal injections can help identify the specific source of pain in the spinal nerve roots. Since there are important structures such as nerves, blood vessels, and the spinal cord nearby, this procedure should be performed by a well-trained Interventional Pain Doctor.
How is the procedure performed?
There are different epidural levels in the spine including cervical, thoracic, lumbar, and caudal. The level of the injection will be determined after a consultation with Dr. Irwin where your symptoms, physical examination findings, and imaging studies will be assessed to determine the appropriate location of the injection. Dr. Irwin will place the injection needle under x-ray guidance. Once in place, the injection will often feel like the normal pain that the patient feels in the distribution of that particular spinal nerve root.
What conditions are treated with a Transforaminal Epidural Steroid Injection?
The conditions most commonly treated with transforaminal epidural steroid injection include radiculopathy, stenosis, herniated disc pain, sciatica, failed back surgery syndrome, or degenerative disc disease.
How Should I prepare for the injection?
If you need something to help with anxiety related to the procedure, you should discuss this with Dr. Irwin. Receiving a pre-procedure medication can help reduce the anxiety. If you are taking any blood pressure medication, you should not skip any regular dose of this medication. However, if you are taking any medications that might thin your blood, you should discuss this with Dr. Irwin to make sure we have approval from your Cardiologist to hold this medication for the appropriate number of days prior to the injection.
On the day of your injection, you should have nothing to eat or drink for two hours prior to the injection. You should have someone who can drive you home from the procedure. You should not return to work the day of your procedure. You can safely resume your normal activity the day after your injection.
What should I expect after my injection?
The steroid might take up to five days to begin to take effect. Prior to this, you might actually have increased pain from injecting a volume of medication near your pain generator. If you have some injection site pain, you can use ice to help reduce pain. Do not use heat until 24 hours after the injection.
How often should I have the injection repeated?
Patients will often receive profound relief from just their first injection. If this is the case for you, and you are happy with your pain relief, then you can cancel any remaining injections. If you have a less than satisfactory level of pain relief from your first injection, we might repeat the injection. If you have not received any relief after two injections we will likely need to change course and pursue other treatments for your pain.
Our hope is that the transforaminal epidural steroid injection will give months of pain relief. If this is the case, we can repeat the injection every few months as needed for pain relief.
Are there things I should look for after having this procedure?
Of course, you can call our office with any questions you might have. There are certain “red flag” warnings that you should call us about, or if it is after clinic hours you should go to your nearest ER. These would include severe or worsening pain, fever over 101, new or worsening weakness, injection site redness or drainage.