A Transforaminal Epidural Injection is a medical procedure involving the injection of medications, typically including a local anesthetic and a steroid, into the lateral opening of the spine where a nerve root exits. This opening is medically known as a “foramen.” There is a small sleeve within the epidural space that extends over the nerve root for a short distance. This epidural root sleeve is positioned just outside the spinal canal. These injections are sometimes referred to as “root sleeve blocks,” “root blocks,” or “transforaminal epidural blocks.”
Am I Eligible for a Transforaminal Epidural Injection?
Transforaminal epidural injections are often recommended for patients experiencing spinal canal or foramen narrowing, which leads to compression of the spinal nerves. This compression can result in radicular pain, characterized by sensations of burning, numbness, and tingling that radiate into the region innervated by the affected nerve. A common example is sciatica, where patients may feel these symptoms extending from their legs down to their feet.

What Are the Advantages of Transforaminal Epidural Injections?
The long-acting steroid injected during this procedure reduces inflammation and swelling of spinal nerve roots and adjacent tissues, alleviating pain, tingling, numbness, and other symptoms linked to such inflammation, irritation, or swelling. Transforaminal injections can also serve as a diagnostic tool to pinpoint the precise spinal nerve root level responsible for the pain.

How Long Does a Transforaminal Epidural Injection Take?
The duration of the actual procedure typically ranges from five to fifteen minutes, depending on the targeted area.

How Is a Transforaminal Epidural Injection Performed?
The procedure is carried out in various positions depending on the treatment site. For most neck injections, patients lie on their side or back, while back injections typically require patients to be on their stomach. Occasionally, alternative positions are used to optimize X-ray imaging. All patients are closely monitored, including heart rate, blood pressure, and oxygen levels. The skin over the treatment area is sterilized with antiseptic solution and numbed using a local anesthetic. A thin needle is then inserted under live X-ray (fluoroscopy) guidance. Once the needle is correctly positioned, the medication is injected, which may cause sensations similar to the pain associated with the affected spinal nerve root. The needle is subsequently removed, and a sterile bandage is applied.

Will the Transforaminal Epidural Injection Be Painful?
The procedure involves inserting a needle through the skin and deeper tissues, which can occasionally be uncomfortable. However, the skin and deeper tissues are numbed with a local anesthetic using a fine needle before the spinal needle is inserted. Once numbed, patients often experience more of a strong pressure and pinching sensation rather than sharp pain when the spinal needle is placed. Some patients opt for intravenous sedation to make the procedure more tolerable, while others undergo the injection without sedation, experiencing minimal pain throughout.

Will I Be Fully Sedated for the Transforaminal Epidural Injection?
This procedure is primarily performed under local anesthesia, although an anesthesia provider may offer light sedation using intravenous medications to enhance comfort. The level of sedation administered depends on the patient, with some experiencing amnesia and potential memory loss regarding parts or all of the procedure.

What Should I Expect After the Transforaminal Epidural Injection?
Following the injection, you may experience temporary sensations of heaviness or numbness in the treated arm or leg, depending on the injection site and the amount of local anesthetic used. Immediate pain relief may also occur due to the local anesthetic. However, this relief typically lasts only a few hours. You might subsequently experience some soreness, increased pain, or aching for a few days, attributed to the mechanical process of needle insertion and irritation from the injected steroid. Pain relief usually begins around the third to fourth day.

What Should I Do After the Transforaminal Epidural Injection?
Due to potential numbness or weakness in the treated limb, driving immediately after the procedure may be difficult and unsafe. Therefore, arranging for transportation home before the procedure is essential. Most patients are advised to take it easy for a day or two following the procedure until the medication has time to take effect. In general, you can resume activities you were able to perform before the procedure without significant limitations.

Can I Return to Work the Day After the Procedure?
You should be able to return to work the day after the procedure, with any discomfort typically limited to the injection site.

How Long Does the Medication’s Effect Last?
The steroid begins to take effect within 3 to 5 days, and its impact can last for several days to several months, with some individuals experiencing relief for several years.

How Many Transforaminal Epidural Injections Are Typically Needed?
If the initial transforaminal injection does not alleviate symptoms within two weeks, a second injection may be recommended. Similarly, if the second injection does not provide complete relief within approximately one to two weeks, a third injection may be advised. However, if there is no improvement after two injections, a third transforaminal injection is unlikely to be beneficial.

Can I Receive More Than Three Transforaminal Epidural Injections?
In a six-month period, most patients do not receive more than three injections, as the effects of the medication typically last six months or longer. Administering more injections increases the risk of side effects from the steroid medications.

Will the Transforaminal Epidural Injection Be Effective for Me?
Predicting the effectiveness of the injection can be challenging. Patients with radiating pain from the spine into the arms or legs tend to respond better than those with pure neck or back pain. Additionally, patients with recent-onset pain may respond more favorably than those with long-standing pain.

What Are the Risks and Side Effects?
While transforaminal injections are generally safe, all medical procedures carry some degree of risk and potential side effects. The most common side effect is temporary pain following the injection once the local anesthetic wears off. Less common risks include spinal puncture, infection, bleeding within the epidural space, nerve damage, or worsening of symptoms. Other risks associated with the long-acting steroid include weight gain, increased blood sugar in diabetics, water retention, and suppression of the body’s natural steroid production when steroids are overused.