Transforaminal epidural injections are a diagnostic and treatment tool for patients who are experiencing chronic pain in their back or neck. Sometimes this pain is localized, but it often radiates from the back into the legs. The injection procedure offers long-term pain relief for many patients.
The Foramen and Spinal Nerves
Spinal foramena are spaces on both sides of the spine between the vertebrae. These spaces form openings that allow the spinal nerves to leave the spinal cord and connect with the body’s peripheral nervous system. Inflammation in the tissues around the spinal nerves creates pressure, and this pressure is experienced as pain.
The inflammation that can affect a spinal nerve may come from any type of disease or injury. The most common causes are herniated discs, arthritis of the spinal joints, spinal stenosis and compression fractures of the spine.
Transforaminal Epidural Injections
Each spinal nerve is encased in a tough sleeve called the dura. A transforaminal epidural injection is an injection around or just under the dura, which is reached by inserting the needle through the foramen. If your doctor suspects that your back or neck pain is caused by a spinal nerve, this type of injection can be used to both diagnose and treat the problem.
Transforaminal epidural injections are typically used when a physical exam, medical history, and MRI scan suggest a problem with a spinal nerve. If your doctor recommends this procedure, it will be done on an outpatient basis and you will go home the same day.
During the injection procedure, which lasts from 15 to 30 minutes, you will usually be lying face down on a table with a pillow under your stomach to create a slight arch in your back. This causes the vertebrae to curve away from each other, making it easier to access the foramena. Light sedation is optional, and can be useful to help you to relax. The injection site will be numbed with a local anesthetic.
Your doctor will insert a long needle through an individual foramen to the area surrounding one of the spinal nerves. A type of real-time X-ray called fluoroscopy is used to show the doctor exactly where the needle is positioned. A dye will be injected so the doctor can see how far the liquid disperses in your tissue. This ensures that there will not be too large an area of treatment.
Once everything appears satisfactory, the doctor will inject a combination of anesthetic, corticosteroid and saline into the area around the spinal nerve. The anesthetic deadens the pain, the corticosteroid provides longer-lasting relief, and the saline helps flush away any inflammatory chemicals that may be in the tissues. You will probably feel pressure at this point in the procedure, but it should not be painful.
When the injection is completed and the needle has been removed, you will be asked to report the degree of pain relief that you experience. A decrease in your pain is an indication that the treated nerve was the source of the pain. After a brief recovery period, you will be allowed to return home, and you can resume normal activities the next day.
Results of Transforaminal Epidural Injections
The initial pain relief that you experience from this injection is due to the anesthetic. This effect will wear off in a few hours. The steroid may take about three days to take effect, but it will last much longer. Some people find that their pain actually increases in the interval between when the anesthetic wears off and the steroid kicks in. This is because the fluids that are injected can put pressure on the nerve that was treated, causing it to send pain signals. This effect is temporary and can be treated with medication.
If transforaminal epidural injections prove to be effective for you, you can expect pain relief that lasts from a week to a year. Perhaps the greatest value is that these injections provide a break in your pain that allows you to begin learning stretching and exercise techniques. This physical therapy can bring lasting results and make any further injections unnecessary. If your doctor recommends more injections, they can be administered up to three times per year.