Lumbar Epidural Steroid Injections – Transforaminal

AKA: Selective nerve root injection
Lumbar: Low back
Epidural: Place where medication is injected (just outside where your nerves are located)
Steroid: Strong anti-inflammatory
Frequency: Up to 6 times/year (1/2 dose of what is used during a lumbar interlaminar epidural)
Transforaminal: Across the foramen (ie where the nerve is leaving your spine)
Anesthetic: Local

Indications: 
Pain typically comes from nerves that become irritated and subsequently swollen (inflamed).  By placing a steroid, which is a strong Anti-inflammatory, on the nerve that is irritated, this decreases the swelling around this nerve which decreases your pain.  This procedure targets a specific nerve(s) that may be causing your pain which has the potential of not only giving you pain relief but also determining a specific diagnosis for your pain.  This is considered a “sniper” approach to pain relief in your low back and buttock/leg(s).  The patients who typically benefit the most from this procedure have low back pain that radiates down one or both legs in a specific pathway.  

Some indications include:

• Herniated/bulging discs that are pressing on nerves in your low back
• Acute/Chronic low back pain usually associated with leg pain
• Continued pain after spinal surgery
• Lumbar degenerative disc disease with possibly a tear in the disc

 
Contraindications/Reasons why you may not have your injection today: 

• Bleeding disorders/low platelet counts
• Medications that thin your blood (please review this section)
• Current infection
• No driver
• Your symptoms have changed and/or improved
• Patient refusal
• Procedure not approved by your insurance
• Poorly controlled high blood pressure that may be giving you symptoms
• Poorly controlled diabetes
• Certain types of glaucoma
• Poorly controlled bipolar disorder
• Allergies to the any of the medications that is being used

 
Potential side effects/risks of the procedure:

• Increased pain
• Numbness in lower extremities that is short lived
• Infection
• Bleeding
• Allergic reaction
• Cramping in lower extremities
• Mood changes
• Flushed face/extremities
• Headaches
• Worsening of high blood pressure
• Increasing of blood sugars if you have diabetes
• Water retention
• Chronic steroids can cause weight gain
• Seizures
• Stroke
• Nerve and/or spinal cord injury

 
Procedure: 
During the procedure, you will be lying on your stomach.  An x-ray machine is used to locate the specific level of the spine which is believed to be causing your pain.  After your skin is cleaned with an antiseptic solution, typically betadine unless you are allergic, a series of x-rays will be taken to guide the needle placement.  The skin is localized with a local anesthetic which is typically the most painful part of the procedure as this medicine has a tendency to burn when it is injected.  After this point, you should only feel pressure.  If anything is too painful for you, please tell your physician as more numbing medicine can be given at any time.  When the needle approaches the nerve, contrast/dye is injected to confirm that the needle tip is next to the nerve and not in a blood vessel and/or in the spinal fluid space.  Next, a solution containing both a local anesthetic and steroid is slowly injected. You may experience increased pressure in your low back/buttocks region which is normal.  At times, you may even feel pressure/increased pain down the leg that is hurting you.  That is also to be expected.  However, if at any time the pain is too intense, please tell your physician to slow down your injection.  After the medication is injected, the needle is removed and the procedure is completed.

Typical length of the procedure: 
5 minutes.  Expect to be at the clinic no more than 15 minutes after you have been checked in by the medical assistant into the preoperative area.  If this is your first time at our clinic, you will likely be at the clinic for at least one hour.  Please plan accordingly.

How long do you expect pain relief: 
It is difficult to determine how long and how much pain relief you may experience.  It varies depending on multiple factors.  Some patients do not gain any relief from the procedure and some may have permanent relief.  If you experience relief right after this procedure, this can be diagnostic that your pain is coming from the specific nerve(s) that was injected today.