Dr. Tural's health blog

Transforaminal Epidural Steroid Injections

Chronic pain can significantly impact one’s daily life, prompting the exploration of effective interventions. Among these, transforaminal anterior epidural steroid injections have emerged as a valuable non-surgical option since their introduction in 1952. This minimally invasive procedure directly targets the source of pain in the spine, offering relief for conditions such as herniated discs, spinal stenosis, and nerve root compression. In this article, we delve into the key aspects of transforaminal epidural injections, covering indications, contraindications, procedural details, and post-treatment considerations.

What is Transforaminal Epidural Injection?

Transforaminal epidural injection is a procedure in which corticosteroids are injected into the epidural space through the neural foramen, the opening through which the spinal nerve exits the spinal canal. These injections provide a focused solution for individuals grappling with pain stemming from nerve irritation in the neck, back, arms, or legs. By directly administering corticosteroids into the epidural space surrounding the spine cord, healthcare professionals aim to mitigate inflammation associated with conditions like herniated discs, spinal stenosis, and nerve root compression, offering targeted relief where it’s needed most.

Transforaminal Epidural Steroid Injections

Indications for transforaminal epidural injection

Transforaminal epidural injections are commonly used to manage conditions such as lumbar radicular syndrome, which is characterized by pain, numbness, or weakness that radiates along the path of a compressed or inflamed spinal nerve root. It can be caused by conditions such as herniated discs, spinal stenosis, or degenerative disc disease.
These injections are especially recommended for individuals grappling with persistent discomfort in the neck, back, arms, or legs due to conditions such as herniated discs, spinal stenosis, or sciatica. When conventional pain management approaches prove insufficient, pain management specialists may turn to transforaminal epidural injections to directly target and alleviate inflammation at its source. The procedure’s efficacy in mitigating nerve-related pain makes it a valuable intervention for patients seeking relief from the debilitating effects of various spinal disorders.


Contraindications for transforaminal anterior epidural corticosteroid injections are crucial considerations to ensure patient safety and optimize treatment outcomes. While this minimally invasive procedure is generally well-tolerated, certain conditions may preclude its use. Pregnant individuals, due to potential risks to the developing fetus, are advised against this intervention. Active infections and bleeding disorders also pose contraindications, as they heighten the risk of complications. A comprehensive assessment of the patient’s medical history is imperative to identify these contraindications and explore alternative pain management strategies. It is through a meticulous evaluation that healthcare providers can make informed decisions, prioritizing patient well-being and tailoring treatment plans to individual circumstances.

How is it performed?

Pre-procedure preparations

An important element of the pre-procedure phase is the consultation with the healthcare provider. During this consultation, patients can expect a thorough review of their medical history, current medications and a discussion of the potential benefits and risks of the procedure. This exchange of information forms the basis for informed decision-making and lays the groundwork for a personalized and patient-centered approach.

Transforaminal epidural injection is preceded by a series of pre-procedural preparations to ensure a smooth and effective intervention. Patients may receive specific instructions regarding medication adjustments, including temporary discontinuation of blood thinners to minimize the risk of bleeding during the procedure. Fasting for 6-8 hours before the procedure may also be recommended.

Monitoring, local anesthesia and sedation

After being positioned on the procedure table, patients’ vital signs such as blood pressure, oxygen level in the blood and pulse rate are monitored. Local anesthesia is used to make the procedure more comfortable. Some patients may need sedatives.

How is the intervention performed?

Transforaminal epidural injection is a meticulously orchestrated process by skilled pain specialists. The patient is placed prone to facilitate access to the spine and fluoroscopic guidance is used to ensure access to the right site for the procedure.

A thin, specialized needle is carefully inserted through a transforaminal approach into the epidural space, a region surrounding the spinal cord and nerve roots. A contrast medium is then administered and fluoroscopy is used to confirm that the tip of the needle is in the correct location.  The therapeutic mixture, which is a combination of local anesthetic and corticosteroids, or sometimes just a corticosteroid solution, is then injected into the area. Targeted placement of the needle is crucial to effectively intervene in the inflamed area and minimize the impact on the surrounding tissues.

During the procedure phase, patients may experience some mild discomfort associated with the insertion of the needle. However, the discomfort is usually temporary and healthcare providers are skilled at managing any immediate concerns to ensure patient comfort and well-being.

Transforaminal Epidural Steroid Injection intervention

Post procedure care

Following the injection, patients enter the post-procedure care phase, a period of monitoring and initial assessment. The duration of this monitoring can vary but is typically short, allowing healthcare providers to monitor for any immediate side effects and ensure the patient is stable before discharge.

Immediately after the injection, it is not uncommon for patients to experience varying degrees of relief, but it can take several days for the benefits to fully manifest. In the post-procedure period, patients are educated on what to expect and provided with guidelines for self-care. This may include physical activity recommendations, restrictions on certain movements, and the use of ice or heat to manage residual discomfort.

Complications of transforaminal epidural injections

While transforaminal epidural injections are generally safe, there are potential complications, including infection, nerve damage, or allergic reactions to the medications used. Patients are usually advised to report any unusual symptoms following the procedure.

Follow-up and long-term management

After undergoing a transforaminal epidural corticosteroid injection, consistent follow-up is crucial for assessing the procedure’s effectiveness and ensuring sustained pain relief. Patients are typically scheduled for a post-procedural follow-up appointment, during which their healthcare provider will evaluate their response to the injection and address any concerns or questions. This collaborative approach allows for personalized adjustments to the treatment plan, ensuring optimal outcomes. Depending on individual responses, further injections may be recommended to maintain and enhance long-term pain management. Open communication between patients and healthcare providers is paramount, as it facilitates the timely identification and resolution of any emerging issues, contributing to an overall improved quality of life for those seeking relief from chronic pain.

Transforaminal epidural corticosteroid injections offer a targeted and effective approach to managing pain associated with various spinal conditions. With careful consideration of indications, contraindications, and a comprehensive follow-up plan, individuals can reclaim their lives from the grips of chronic pain. Always consult with a healthcare professional to determine the most suitable treatment plan for your specific situation.