Transforaminal Epidural Steroid Injection

A lumbar transforaminal epidural steroid injection is an outpatient procedure for treating lower back pain. This information will explain what it is, Dr. Singer can determine if it is for you.

What is the epidural space?
The dura is a proactive covering of the spinal cord and its nerves. The space surrounding the dura is called the epidural space. In the lower back it is called the lumbar epidural space.

What causes pain in the epidural space?
The lumbar region of the spine consists of five vertebrae. Soft discs located between these vertebrae provide cushioning, maintain structural integrity, and facilitate movement. If a disc becomes damaged or tears, chemicals may leak out, potentially leading to inflammation of the dura mater or the nerve roots, resulting in pain. A significant disc tear can cause the disc to bulge, further irritating the dura and nerve roots, which can also lead to discomfort. Additionally, bone spurs, known as osteophytes, can develop and exert pressure on the nerve roots, contributing to pain in this area.

How do I know if I have disc and nerve root pain?
If you have pain in your lower back when you move, you may have lumbar disc or dural inflammation. Common tests such as MRIs can show disc bulges and nerve root compression, but may not show a torn and leaking disc. A lumbar epidural injection may provide relief if disc, dural, or nerve root inflammation is causing your pain.

What is a lumbar transforaminal epidural steroid injection?
In a lumbar epidural injection, a steroid (anti-inflammatory medication) is injected into the epidural space to reduce inflammation. A local anesthetic (numbing medicine) may also be injected. When it is done from the side where the nerve exits the spine, it is called a transforaminal injection. This technique puts the medication near the source of the inflammation.

What happens during an injection?
A local anesthetic will be used to numb your skin. The doctor will then insert a thin needle directly into the epidural space. Fluoroscopy, a type of x-ray, must be used to ensure the safe and proper position of the needle. A dye may be used to make sure the needle is at the correct spot. Once Dr. Singer is sure the needle is correctly placed, the medicine will be injected.

What happens after an injection?
You will be free to get re-dressed and check out at the front desk. It may help to move your lower back in ways that hurt before the injection, to see if the pain is still there, but do not overdo it. Take it easy for the rest of the day. You may feel immediate pain relief and some numbness in your lower back for a limited time after the injection. This may indicate the medication has reached the right spot. You can usually return to work the day after the injection. Your pain may return after this short pain-free period or may even be a little worse for a day or two. It may be caused by needle irritation or by the steroid itself. Steroids usually take two or three days to start working but can take as long as a week.

How long can I expect pain relief?
The extent and duration of pain relief may depend on the amount of disc, dural or nerve root inflammation. Other coexisting factors may be responsible for your pain. Sometimes an injection brings several weeks to months of pain relief and then further treatment is needed. Other times, a single injection brings long-term pain relief. If your pain is caused by injury to more than one area, only some of your symptoms may be helped by a single injection.