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Lumbar Transforaminal Epidural Steroid Injection

What does Lumbar Transforaminal Epidural Steroid Injection mean?

Here is an explanation of each word:

  1. Lumbar: the parts of the spine located in the mid-back
  2. Transforaminal: through a foramen, which is the opening on the side of the spine where the spinal nerves leave the spine.
  3. Epidural: a space outside of the lining of the spinal cord and spinal fluid
  4. Steroid: a powerful anti-inflammatory medication sometimes called “cortisone”

Altogether, “Lumbar Transforaminal Epidural Steroid Injection” means to inject a steroid around a specific spinal nerve at the point where it leaves the spine. The medication follows the nerve back into the spine.

Why is a Lumbar Transforaminal Epidural Steroid Injection done?

A Lumbar Transforaminal Epidural Steroid injection is a procedure often done as a treatment for pain from disc herniations in the low-back. The disc herniation can cause inflammation of the spinal nerve next to it, resulting in back and leg pain. This inflammation is the target of the procedure. The steroid is a powerful anti-inflammatory medication which can relieve the inflammation and pain.

Another reason for Lumbar Transforaminal Epidural Steroid Injections is narrowing of the foramen due to degeneration such as bone spurring which narrows the foramen and places pressure on the spinal nerve.

What is the difference between a Lumbar Interlaminar Epidural Steroid Injection, a Lumbar Transforaminal Epidural Steroid Injection, and a Lumbar Nerve Root Block?

All three injections are often done for an inflamed disc and spinal nerve in the mid-back, most commonly due to a disc herniation. The difference between them is where the medication is delivered. Some of this may depend on the location of the disc herniation or the preference of the doctor performing the injection. One type of injection is not necessarily better than another.

Here is where each injection delivers the medication:

  1. Lumbar Interlaminar Epidural Steroid Injection:

The medication is injected into the main epidural space on the back of the spine, just outside the spinal cord and its lining (dura). The injection spreads around multiple spinal nerves.

      2. Lumbar Transforaminal Epidural Steroid Injection:

The injection is done from around the side of the spine. The medication is injected through the foramen (opening where the spinal nerve leaves the spine and travels to the leg) and follows the spinal nerve back into the spine. The injection is done for a specific spinal nerve.

      3. Lumbar Nerve Root Block

This injection is very similar to the Lumbar Transforaminal Epidural Steroid Injection. The difference is that the medication is injected outside of the foramen and follows the nerve away from the spine, rather than back into the spine. The injection is done for a specific spinal nerve.

How is a Lumbar Transforaminal Epidural Steroid Injection done?

Here are the steps of how a Lumbar Transforaminal Epidural Steroid Injection is done:

  1. The procedure is usually done in a Procedure Room or Operating Room.
  2. The patient may receive relaxing medication (sedation) with an intravenous catheter (IV).
  3. The patient is placed on the stomach (prone)
  4. The low-back (lumbar spine) is cleaned with a surgical antiseptic and sheets (drapes) are used to keep the area clean.
  5. The doctor will then inject a small amount of a local anesthetic under the skin.
  6. Next, a specialized needle (spinal or procedure needle) is placed through the anesthetized area.
  7. At this point, typically an X-Ray machine is used to see the tip of the needle as it is slowly advanced towards the foramen (hole for the spinal nerve).
  8. When the needle tip appears to be in a good position close to or barely in the foramen, a small amount of contrast material (fluid which looks dark on an X-Ray) is injected through the needle to verify that it is in the correct location.
  9. Next, a mixture of medication is injected into the epidural space. This mixture may consist of a steroid, a local anesthetic, or a pain killer.
  10. The needle is withdrawn.
  11. A band-aid is placed.
  12. The patient is then taken to a Recovery Area for a period of observation.

How long does it take to do this procedure?

Typically a Lumbar Transforaminal Epidural Steroid Injection takes 5-10 minutes to complete.

How much relief can patients gain from a Lumbar Transforaminal Epidural Steroid Injection?

The relief from spine injections can vary. If the injection is done for an inflamed spinal nerve, the relief can be substantial or complete. It could last for weeks to months.