Pain Management Services
Transforaminal Epidural Injections
Transforaminal Epidural Steroid Injections
An epidural is the space surrounding the dural – a protective covering of the spinal cord and its nerves. Nerves in the epidural space may become pinched by a bulging disk, bone spur, or narrowed nerve canal. This inflames the nerves, causing pain, numbness, or tingling.
Epidural injections can calm the inflammation by injecting an anti-inflammatory corticosteroid into the epidural space. When the injection is made from the side where the nerve exits the spine, it is called a transforaminal injection. This technique puts the medication near the source of inflammation.
Sierra Neurosurgery Group provides 3 types of transforaminal epidural steroid injections:
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.
What can I expect during the procedure?
This outpatient procedure takes about an hour. First, we numb the skin around the affected area. Then we inject the anti-inflammatory. You may feel your legs become heavy or numb, but this wears off in time. You should feel pain relief within 2 days after treatment.
How long is the recovery time?
We suggest you move easily the first day of the procedure. Most patients go back to work after treatment and return to full activity the next day.
How long does relief last?
This varies per patient. Generally, the steroid begins working 2-7 days after treatment and relief lasts for several days to a reasonably long time. Usually, patients require a series of three injections spaced about two weeks apart. You should expect gradual improvement after each injection.
If pain persists after your first three injections, you should wait at least 6 months before continuing another series of injections.
What are the risks and side effects of epidural steroid injections?
The most common side effect is temporary pain at the injection sites. Very rare risks include: infection, bleeding, nerve damage, no pain relief, and accidental puncture of the spinal fluid sack, which may cause headaches and can be treated. The injected steroid may temporarily cause water retention, flushing, sweating, weight gain, increased blood sugar (mainly in diabetics), or heart palpitations for a few days.
Who should not have this injection
You should not have this procedure if you are:
- Allergic to any of the medications to be injected
- On a blood thinning medication (e.g. coumadin, injectable heparin)
- Currently battling an active infection
- On anti platelet drugs (ask your doctor if you can temporarily discontinue use before the procedure)