What is a transforaminal epidural steroid injection?

Epidural steroid injections are used in the treatment of significant radiating back or pain that has not responded to oral anti-inflammatory medications, rest, ice/heat therapy, and physical therapy. A needle is inserted into the epidural space of the spinal cord and steroids are injected. “Transforaminal” simply refers to the location the needle is inserted in relation to the spine. Steroids decrease inflammation; by injecting them into the epidural space, the medication can work directly on the inflamed nerve root. This procedure can be used for pain in the neck or back. A small amount of local anesthetic will be injected into the skin at the site of injection. Your provider will insert a needle into the space between your vertebrae and inject contrast dye into your cerebrospinal fluid. This, combined with an x-ray machine, is called fluoroscopy and allows your provider to better visualize where the steroids should be injected.

Am I a candidate for transforaminal epidural steroid injection?

You are a candidate for transforaminal epidural steroid injections if you have pain that radiates from your back or neck that is caused by a herniated disk, spinal stenosis, compression fracture, or nerve pain caused by shingles. There may be other causes for your radiating back pain for which your provider suggests this therapy. If you have a blood infection or infection at the injection site, if you are at full doses of blood thinners, have a bleeding disorder, or have had serious allergic reactions to any of the medications. These medications include steroids, anesthesia medicines, or contrast dye. Tell your doctor if you are (or might be) pregnant as pregnant women should not undergo fluoroscopy. If you have uncontrolled diabetes, you might not be a candidate because the steroid medication can cause severe hyperglycemia. Fluid retention may also be caused by the steroids; tell your doctor if you have congestive heart failure.

How long will the transforaminal epidural steroid injection procedure take?

Transforaminal epidural steroid injections do not take much time. Your back or neck will be cleansed, a local anesthetic will be injected to your skin at the injection site, and contrast dye is injected into your spinal cord. Once your provider has visualized, with fluoroscopy, the proper site for steroid injection, the steroid is administered. Following the procedure, you will need to remain in the office for a brief period of observation. In rare cases, you may experience a serious headache due to the increase in cerebrospinal fluid. Rarer still, an allergic reaction may occur to the contrast dye or steroid medication, which could require a trip to the emergency department. For the vast majority of patients, however, the procedure is over quickly.

How long will it take to recover from a transforaminal epidural steroid injection?

The recovery for transforaminal epidural steroid injections is minimal. You might experience a headache following the procedure, but that should subside in a few hours. It may take up to two weeks to experience relief from your radiating back pain. You will likely require multiple injections, two weeks apart. Your provider will assess your response to the injection and determine if additional injections would be beneficial.


Chen, B. 2017. Epidural Steroid Injections. Medscape. Retrieved from http://emedicine.medscape.com/article/325733-overview#a1.