Lumbar Transforaminal Epidural Steroid Injection

A transforaminal epidural steroid injection is the injection of steroid into the opening at
the side of the spine where the nerve root exits. This opening is known as the foramen.
There is a small sleeve of the epidural space that extends out over the nerve root for a
short distance. The epidural root sleeve is just outside the spinal canal. These injections
may also be known as selective nerve root injections.

What are the advantages of transforaminal ESI?

May increase success in reducing pain. The main advantage of transforaminal ESI is that the doctor can deliver the medicine into the neural foramen that contains the actual nerve root in question, which can increase the likelihood of success in reducing the patient’s pain.

Helps ensure focus on the correct nerves. Another advantage is that the doctor can inject lidocaine – a numbing medicine – which works immediately (but temporarily) to numb the nerve root. If the numbing medicine immediately relieves the patient’s pain, the physician then knows that the correct area has been reached. This can help ensure that steroid injections or surgery that will be done are focusing on the correct nerves.

What are some considerations?

Spine injections should only be done by doctors with special training. Before the ESI procedure, the doctor will get detailed pictures of the spine using MRI or CT scan, which will help determine the best approach.

What happens during the procedure?

  1. The patient lies face down on a table.
  2. Numbing medicine is injected into the back.
  3. Contrast dye is injected into the area so that the structures will be visible on X-ray.
  4. Using X-ray guidance, the doctor then places the steroid medication into the precise area believed to be causing the problem.

The procedure takes about 15 minutes. The patient is then observed for 20-30 minutes before going home. The arms or legs can be weak for a brief time after the procedure because of the numbing medicine, so patients are asked not to drive themselves home and to take care when moving about for the rest of the day.

Patients may have slight discomfort for a few days after the procedure, before they begin to feel the benefits of pain relief.

Does ESI work? For how long?

Provides pain relief for many. Many patients who undergo ESI have a significant decrease in arm or leg pain.

Usually lasts about 6-12 weeks. It can take a few days for the effects to be known. If the pain gets better, the effects usually last about 6-12 weeks.

If needed, the procedure can be repeated. Patients who do get better may not get complete relief of their pain. A realistic goal is to achieve a major reduction in the level of pain.

Common Misconceptions about ESI

Frequency of the procedure. Many people think that ESI must be done three times in order to work, or that three times is the maximum number of treatments that can be given. Both are incorrect. Some patients get relief after one or two treatments, others need more. Your doctor can give you more information on how many treatments you may need.

An epidural – like in childbirth? No. An epidural steroid injection is not the same thing as epidural anesthesia used in labor and delivery, or for certain surgeries.

Number of “sticks.” People who may have had epidural anesthesia – for childbirth or for a surgical procedure – may be concerned about the discomfort associated with multiple needle sticks to the back. Unlike epidural anesthesia, ESI is done under X-ray guidance. This means the doctor can see exactly where to place the injection, eliminating the need for multiple sticks. Headaches, and other complications sometimes seen with epidural anesthesia, are rare following ESI using a transforaminal approach.

Your doctor can answer your questions about epidural steroid injections as well as any other questions you have about your spine health. Please be sure to discuss all your questions and concerns.