Lumbar Transforaminal Epidural Steroid Injection
The foramen refers to the opening in between the vertebrae and at the side of the spine where a nerve root exits. Through such procedure as a lumbar transforaminal epidural steroid injection, this specific area of the epidural space is targeted and injected with anti-inflammatory medication.
Purpose and Advantages
The procedure in focus can have both therapeutic and diagnostic purposes. For the latter, the steroid injection alongside the anesthetic medication could help determine the cause of the symptoms of the pain in the lower back and pain that radiates from the lumbar spine to the legs. Moreover, it could also help determine whether or not the foramen is indeed the cause of pain. For therapeutic purposes, this procedure has a higher likelihood of success in reducing inflammation and swelling of irritated spinal nerves because the medication is delivered directly into the neural foramen that contains the actual nerve. Precision is key in an injection such as this, which is why this procedure ensures a more focused approach on the correct nerve.
What is injected
A longstanding steroid is injected into the targeted nerve. The medication is a mixture of saline, local anesthetic, and long acting steroid. This ensures a pain relief that will not wear off anytime soon.
Considerations and Contraindications
Although this procedure may seem like the best option for immediate and long standing pain relief, there are of course things to consider before a patient undergoes such procedure. Patients with heart disease or diabetes may not be recommended for this procedure due to the effects of the steroids on blood glucose level and blood pressure. Also, patients taking blood thinners bleed more easily which places the patient at increased for more serious complications such as nerve injury, stroke or even death.
The procedure process
The patient is made to lie, face down on the procedure table. In some instances, a pillow is placed under the abdomen area to ensure a curved lumbar area for easier access of the foramen. A numbing medicine of local anesthetic is given to the patient to numb the tissue and skin to be injected. Next, a contract dye comes after to make sure that the actual medication hits the correct targeted nerves. Through the guidance of an x-ray, a steroid medication is placed around the specific nerve causing the pain or the problem. The injection will be withdrawn and the patient is made to rest for 20-30 minutes for observation and feedback.
Follow up repeat injections may come every two weeks if there are no signs of relief or depending on the physician’s advice. The patient cannot drive within 24 hours after the procedure, so any transportation concerns should be pre-arranged. The arms and legs weaken, which is a normal side effect of the steroid medication. The patient may resume daily routine activities after a day unless otherwise stated by the doctor. Uncommon risks include:
- spinal puncture with headaches
- bleeding inside the epidural space
- nerve damage
- worsening of symptoms