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What is Transforaminal Epidural Steroid Injection?

The epidural space of the spine is the area between the vertebral bones and the protective dura sac that surrounds the spinal cord and nerves.

A steroid injection consists of an anti-inflammatory medication called a corticosteroid, that is combined with an anesthetic and injected into the body to relieve pain and inflammation.

A transforaminal epidural steroid injection is a minimally invasive procedure where medication is injected into the opening at the side of the spine where the nerve roots exit, called the foramen.

It is useful for treating the pain associated with the back, neck, arms or legs by reducing inflammation of the spinal nerves caused by disc herniation or spinal stenosis.

Indications

A transforaminal epidural steroid injection is indicated for people suffering from the following conditions:

  • Degenerative Disc
  • Herniated Disc
  • Spinal Stenosis
  • Sciatica
  • Spondylolisthesis

What are the Contraindications of Transforaminal Epidural Steroid Injections?

Transforaminal epidural steroid injections are contraindicated under the following conditions:

  • If you have bleeding problems or
  • infection is present

Care should be taken for the following people:

  • Diabetics
  • People on blood-thinning medications
  • High blood pressure (hypertensive) patients
  • Patients with glaucoma
  • Pregnant women, as it may be detrimental to the baby

Preparation for a Transforaminal Epidural Steroid Injection

A transforaminal epidural steroid injection is usually performed as an outpatient procedure using a live x-ray called fluoroscopy.

You will be asked to:

  • Sign consent forms
  • List your current medications
  • List allergies to any medications

The entire procedure lasts about 15-45 minutes.

Your doctor will inject the medication as close to the painful nerve as possible to provide the best results.

How is the Transforaminal Epidural Steroid Injection Introduced?

Administering a transforaminal epidural steroid injection involves three steps:

Step 1: Patient Preparation

You will lie on an x-ray table on your stomach. A local anesthetic will be used to numb the treatment area to keep you comfortable.

You will be kept awake during the procedure but may be given a sedative to put you at ease if needed.

Step 2: Needle Insertion

Your doctor inserts a hollow needle through the skin into the epidural space between the bony vertebrae with the help of live x-ray images from fluoroscopy. You may feel slight pressure or pain.

Step 3: Injecting the Medication

After ensuring the needle is in the correct position, the corticosteroid and anesthetic combination is injected into the epidural space around the nerve roots. The needle is then removed and a small dressing placed over the insertion site.

The procedure may be repeated in other spinal regions depending on the location of your pain.

What is Post-Injection care?

After you have received a transforaminal epidural steroid injection, you should be able to walk around immediately, however, some people may find it difficult right away. You will be monitored in the recovery room for any adverse reactions for a short period of time and later discharged.

  • You should have someone drive you home after the injection procedure.
  • You may be prescribed pain relievers and ice to relieve soreness around the injection site.
  • You should be able to resume full activity the next day.
  • If you feel increasing discomfort or pain, you should contact your physician immediately.

What is the Risks and Complications of Transforaminal Epidural Steroid Injection?

Transforaminal epidural steroid injections are a relatively safe, non-surgical treatment. However, puncture of the dura sac may occur during needle insertion and can cause:

  • Spinal bleeding
  • Infection
  • In rare cases, nerve damage/ paralysis

Corticosteroid medication may cause:

  • Water retention
  • Weight gain
  • Mood swing
  • Hot flashes (Flushing)
  • Insomnia
  • Elevated blood sugar levels in diabetics

Minor side effects include muscle weakness or numbness that usually resolves within 8 hours in the affected leg or arm.

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