What to know about transforaminal epidural steroid injections

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A transforaminal epidural steroid injection is delivered via an epidural spinal needle into an opening on the side of the spine called the foramen. This opening allows access to the nerve root.

The injection is made up of the following components:

• local anesthetic (bupivacaine or lidocaine)
• steroids (triamcinolone acetate, methylprednisolone acetate, betamethasone acetate, or phosphate/dexamethasone phosphate)
• a contrast solution

A transforaminal epidural steroid injection is primarily used to relieve pain and reduce inflammation. While the local anesthetic provides short-term pain relief, the steroid can provide long-term relief that lasts for weeks or even months.

Before the procedure, it is important that the individual receiving the injection lets their healthcare professional provider know whether they:

• have diabetes that they treat with medication
• have recently been admitted to the hospital
• have an infection they are treating with antibiotics
• have tested positive for methicillin-resistant staphylococcus aureus (MRSA), a type of bacteria
• may be pregnant

If the person takes any blood-thinning medications (anticoagulants), they should inform their doctor or other healthcare professional at least 10 days before the procedure. The doctor may advise them to stop taking these medications for a week or so prior to their injection.

It is important that anyone receiving this treatment fully understands the procedure, including having had their healthcare professional explain any potential side effects or risks.

On the day

The healthcare professional may advise that a person does not eat or drink for 4–6 hours before the procedure.

Also, adequate transportation needs to be arranged beforehand. The person undergoing the procedure must ensure they have an adult companion to pick them up by car or taxi afterward. They will not be able to travel home via public transport.

Different techniques exist. The procedure steps for one of the techniques are as follows:

1. The patient will lie flat on their stomach with their neck/back exposed.
2. The doctor will clean the injection site with an antiseptic solution — this may lead to a cold sensation — and the area will be dressed with sterile sheets.
3. Then, the doctor will inject a local anesthetic into the injection area to numb the skin and the tissue underneath. The patient may feel some pressure and discomfort at this point, but it should not be painful. If the patient is feeling pain, they should tell the doctor immediately.
4. The doctor will use an X-ray, ultrasound, or a combination of the two imaging tests to insert an epidural needle and guide it toward the area they are treating. The needle size and the depth of insertion will depend on the individual patient and procedure.
5. The doctor will position the needle in the foramen (the space in the spine where the nerve root is exposed).
6. Next, the doctor will inject contrast fluid to ensure the needle is positioned correctly.
7. Then, the steroids and local anesthetic are injected via the needle into the epidural space.
8. Finally, the needle will be removed, and pressure will be applied to the site to prevent bleeding.

After the procedure, some people may feel immediate pain relief. However, this may not last. The steroid can take 24–72 hours to take effect. The individual may not feel the benefit for up to a week.

Sometimes people may find their pain worsens immediately after the procedure but lessens after a few days.

According to research, the pain relief after the injection may last from 1 week to 1 year, and a person may require more injections in the future.

A transforaminal epidural steroid injection is not designed to cure pain but rather provide temporary relief so that the person can resume typical activities, heal, and continue other treatments.

Recovery time

Immediately after the procedure, the patient will stay in the hospital and recover for 30 minutes to an hour. Afterward, they can return home with an adult companion.

A person can expect to feel pain at home for a day or two. During this time, it is advised that they continue taking any regular pain medication.

Gradually building up the activity level over the following days may be a good way to strengthen the muscles, but it is important that people do not push themselves too far or try extreme activities. This gradual increase in activity should naturally progress until the person feels they can resume their typical activity level.

Transforaminal epidural steroid injections are generally safe. However, some common side effects and rare serious complications are associated with it.

Common side effects include:

• bleeding, bruising, and tenderness at the injection site
• feeling weakness, numbness, or tingling in the limbs for up to a few days after the procedure
• vasovagal reaction to injection, which can include the following:
  • light-headedness
  • dizziness
  • palpitations
  • weakness
  • nausea
  • feeling hot or cold
  • fainting
• temporary increase in pain lasting for a few days

Rare side effects and complications can include:

• infection
• nerve or spinal cord damage
• paralysis
• stroke
• blood vessel damage
• convulsions
• spinal headache (severe headache caused by leaking spinal fluid)
• allergic reaction
• death

Below are some answers to common questions on the topic:

How long does a transforaminal epidural steroid injection last?

Having the injection can take around 10–15 minutes. An additional 30–60 minutes rest period following the procedure may be necessary.

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

Epidurals are injected at different parts of the spine depending on the medical need. In the case of a transforaminal epidural, the injection is across the foramen.

How painful is a transforaminal epidural steroid injection?

The doctor numbs the site with a local anesthetic before they give the epidural. In most cases, discomfort is minimal, but the patient should inform the doctor if they feel significant pain.

How often can a person get a transforaminal epidural steroid injection?

This can vary. Typically, a person may receive 3–4 transforaminal epidural steroid injections per year. They will generally not receive more than three over a 6-month period.

Doctors use transforaminal epidural steroid injections to help treat pain associated with various conditions that affect the back, neck, arms, and leg. It involves injecting local anesthetic and steroids into an opening in the spine that houses the nerve root.

The intended outcome of this procedure is providing temporary pain relief to allow an individual to heal and improve their quality of life.

Although this procedure is generally safe, there are possible side effects and complications ranging from mild to severe.

It is important that anyone considering receiving or planning to receive this treatment fully understands the process and possible side effects. Talking with a healthcare professional who can provide this information is a good first step.