What is a Transforaminal Epidural?

A transforaminal epidural, sometimes called a epidural glucocorticoid injection, is a shot given to the spinal nerve to relieve extreme back or leg pain. Usually, it is given to allow the patient time to heal from an injury, to work on physical therapy exercises, and sometimes as a method of avoiding possible surgery. The drug that is injected is an anti-inflammatory medication called cortisone. Two specific categories of this injection are the transforaminal thoracic epidural injection, given to the mid-back area, and the transforaminal lumbar epidural injection, which is given to the lower back. The former delivers the medication to the rib cage area and middle of the back, while the latter reduces pain to both the lower back and the legs.

Before having a transforaminal epidural, patients should inform the doctor if they have any medical conditions, such as allergies or a bleeding disorder, or if they take any medications, such as blood thinners. Some patients may wish to receive a mild sedative before the transforaminal epidural injection. This may be given intravenously. Patients will then lie on their abdomens on an x-ray table while the injection area is sterilized. The area of skin is then numbed and a fluoroscope, which is an imaging device, is used to ensure the correct placement of the needle, along with an injected contrast dye.

Once the doctor has a clear image of the exact area, he will insert the needle containing cortisone medication into the spinal nerve. It is fairly common for patients to notice some numbness for a few hours after the injection, which may occur in the chest, leg, or arm. They must avoid driving for the rest of the day and refrain from strenuous physical activities. Normal activities and driving may be resumed on the following day, and patients should begin working with their physical therapists. Ice should be applied to the injection area about every four hours for the first day.

Patients should report any changes in their pain levels to the doctor. For example, if a person immediately feels better following the injection, the nerve that was injected is the root cause of the pain. This is helpful for diagnostic purposes, and the doctor can then use additional treatments to address the patient's specific medical condition, as needed. Other patients may feel partial pain relief after the transforaminal epidural, followed by a gradual pain reduction over the next few days. For those who obtain only partial pain relief, up to two additional transforaminal epidurals may be scheduled about two to four weeks apart.

In general, complications from a transforaminal epidural are uncommon. Some patients may experience bleeding, infection, and nerve damage. Discomfort for the first few days, soreness, and elevated blood sugar levels have also been reported. Rarely, paralysis, a worsening of the pain, or failure of the injection to improve the pain may occur. Those who experience side effects should contact the doctor as soon as possible.