What Is A Lumbar Transforaminal Epidural Steroid Injection?
A lumbar transforaminal epidural steroid injection is a commonly used treatment method for radicular pain and lower back pain that is minimally invasive. Before this type of approach was established, conditions such as sciatic nerve pain or lumbar pain were usually treated with more invasive procedures such as surgery. Lumbar pain is characterized as pain that is felt in the lower back, although it may also radiate into the buttocks, thighs, and legs.
Clinical research has been repeatedly published that supports the use of epidural steroid injections for chronic pain and even intense, acute pain. The medication takes effect rapidly and pain relief usually persists for long periods of time, especially if the injection is repeated more than once. Most individuals who suffered from decreased mobility or had to miss work due to their back pain can quickly return to their normal activities after receiving steroid injections.
Clinicians and researchers have tried to elucidate the mechanism that makes epidural steroid injections so effective, but to date this information is still somewhat unclear. It has, however, been proposed that injecting an anesthetic along with anti-inflammatory steroids reduces pain that develops due to nerve damage as well as inflammation. The administration of steroids also helps restore the structure of the membranes that surround the nerves and hinder ion conduction. The restored structural integrity of the membranes along with reduced signal transmission is associated with reduced pain.
How Is A Lumbar Transforaminal Epidural Steroid Injection Performed?
Steroid injections are administered to specific regions along the spinal cord. The spinal cord is a complex structure that contains numerous nerves that extend throughout the entire body and control many processes. Cerebrospinal fluid (CSF) protects and cushions the nerves. The spinal cord is also protected by the spinal canal and is held in a stable position by a firm membrane. The area that is directly outside of this membrane, called the epidural space, is where the medication is injected. The roots of damaged nerves are the targets for steroid injections and the nerve roots are located in the epidural space.
Prior to the administration of the injection, topical anesthesia is applied to the skin to reduce discomfort. There are different approaches that are used to insert the injection needle such as through the middle of the back (the interlaminar method) or the tailbone (the caudal method), but the transforaminal approach is one of the most effective methods. This technique involves inserting the needle through the side of a targeted spinal bone (vertebra) and then delivering the medication to the epidural space. Performing the injection in this manner reduces the formation of scar tissue along the spine. Furthermore, if a patient has bone grafts from a previous back surgery, inserting the needle through the side prevents the grafts from being affected. The occurrence of side effects and complications such as persistent headaches is also extremely low when the transforaminal technique is used to inject the medication.
In order to ensure that the needle is inserted at the right position during the first attempt, a physician uses imaging technology (e.g., fluoroscopy) to guide the placement of the needle. In addition, before the medication is administered a contrast dye is injected as a means of observing whether the medication will be properly distributed to the affected nerves. The entire procedure takes approximately 15 minutes and is therefore an outpatient procedure. However, directly after it has been performed, a patient’s arms and legs may feel weak due to the injection of the anesthetic, but the weakness wears off fairly quickly.
Patients who receive lumbar transforaminal epidural steroid injections generally report experiencing dramatic relief almost immediately after the injection or within a few days. If a patient only experiences minor relief, the injection can safely be repeated several additional times. Research has even shown that lumbar transforaminal epidural steroid injections are so effective that individuals who receive them shortly after the back pain develops are less likely to need invasive back surgery.
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Conditions Related To Lumbar Transforaminal Epidural Steroid Injections
Steroid injections have successfully been used to treat numerous conditions, which include:
- Lumbar spinal stenosis, a condition that is characterized by an abnormally narrow spinal canal
- A herniated disc, which refers to a ruptured or bulging spinal disc
- Degenerative disc disease, which refers to the gradual wear and tear of spinal discs
- Degenerative lumbar spondylolisthesis, a condition that occurs when a spinal disc slips out of place and onto the disc below it
- Lumbar radiculopathy, a condition that is characterized by lumbar back pain that extends into the buttocks and down the legs due to compressed spinal nerves
Conclusion
A lumbar transforaminal epidural steroid injection is an effective procedure that is quickly becoming a commonly used treatment for back pain, especially due to its ability to prevent patients from needing back surgery. Lumbar back pain is a serious problem for many adults and this treatment method is currently being recommended before more invasive approaches are discussed.
The transforaminal technique that is utilized to perform the injection involves administering medication through the side of the spine and this has been shown to reduce the formation of scar tissue as well as the occurrence of complications. This particular approach to epidural injections is becoming more popular than other methods due to the reduced incidence of side effects. In addition, most patients who receive one or more steroid injections report rapid and dramatic pain relief as well as enhanced mobility and range of motion, which allows them to quickly return to their daily routines.
References
- Gündüz OH, Akhlaque U, Sencan S, Celenlioglu AE, Seker A. Contralateral lumbar radicular pain shortly after a transforaminal epidural steroid injection: an unusual sequel. Am J Phys Med Rehabil. 2014; 93(9):834-5.
- McCormick S, Cushman D, Casey E, Garvan C, Kennedy DJ, Plastaras C. Factors Associated with Pain Reduction after Transforaminal Epidural Steroid Injection for Lumbosacral Radicular Pain. Arch Phys Med Rehabil. 2014; in press.
- Manchikanti L, Cash KA, Pampati V, Falco FJ. Transforaminal epidural injections in chronic lumbar disc herniation: a randomized, double-blind, active-control trial. Pain Physician. 2014; 17(4):E489-501.
- Kraiwattanapong C, Wechmongkolgorn S, Chatriyanuyok B, Woratanarat P, Udomsubpayakul U, Chanplakorn P, Keorochana G, Wajanavisit W. Outcomes of fluoroscopically guided lumbar transforaminal epidural steroid injections in degenerative lumbar spondylolisthesis patients. Asian Spine J. 2014; 8(2):119-28.
- Murthy NS, Geske JR, Shelerud RA, Wald JT, Diehn FE, Thielen KR, Kaufmann TJ, Morris JM, Lehman VT, Amrami KK, Carter RE, Maus TP. The Effectiveness of Repeat Lumbar Transforaminal Epidural Steroid Injections. Pain Med. 2014; in press.
- Kim HJ, Yeom JS, Lee JW, Chang BS, Lee CK, Lee GW, Im SB, Kim HJ. The influence of pain sensitivity on the treatment outcome of transforaminal epidural steroid injection in patients with lumbar spinal stenosis. Pain Pract. 2014; 14(5):405-12.