Lumbar Transforaminal Epidural Steroid Injection

Lumbar disc degeneration and disc bulging are part of the wear and tear of life. However, when a disc bulges or protrudes sufficiently to cause compression and inflammation of a lumbar nerve root, treatment may be
necessary.

Causes of Lumbar Nerve Inflammation
1. Lumbar disc bulging or herniation
2. Lumbar disc degeneration
3. Narrowing of the bony opening around the nerve root (neuroforaminal stenosis)
4. Lumbar disc tears which release nerve irritating enzymes
5. Narrowing of the spinal canal (spinal stenosis)

Signs and Symptoms of Disc Pain
1. Burning pain in the buttocks and down the leg
2. Numbness and tingling in the leg and foot
3. Pain usually worsens with sitting
4. Low back pain and muscle spasm

Physical Examination
You will be asked to come to the office of Pain Management Northwest where your Pain Management physician will provide a thorough physical examination to determine the cause of your pain. If you have an inflamed lumbar nerve root further studies may be needed to determine the source of your pain.

Radiology Studies to Determine the Source of Your Pain
An MRI scan is the best test to determine which of your lumbar discs may be compressing and inflaming your lumbar nerve root. In some situations a CT scan, myelogram and nerve conduction studies are done.

Treatment of an Inflamed Lumbar Nerve Root
1. Rest
2. Anti-inflammatory medication
3. Muscle relaxants
4. Transforaminal epidural steroid injection

When rest, anti-inflammatory medication and muscle relaxants are ineffective, a transforaminal epidural steroid injection may be necessary.

What does transforaminal mean?
It means going through an opening. The foramen is the bony opening between the vertebrae through which the lumbar nerve root exits the spine and travels down to the leg. It is in this bony opening where the lumbar nerve root becomes compressed between the disc and the bony wall of the opening or foramen. To treat the inflamed nerve root anti-inflammatory medication must be introduced into the foramen where the nerve is being compressed. 

What is a transforaminal epidural steroid injection?
You will be asked to lie on a special x-ray table. You will be given light intravenous sedation and local anesthetic in the area over the nerve root opening. Using live x-ray (fluoroscopy) a needle will be guided into the opening where the nerve root is being compressed. A dye solution that can be seen on our x-ray monitor is injected so that we can determine the extent to which the nerve is being compressed. Local anesthetic is then injected around the nerve root to relieve your pain. A steroid medication is also injected around the nerve root which acts as an anti-inflammatory medication to decrease the inflammation and swelling of
the nerve root.

What to Expect
After your procedure you will be monitored in a recovery area for 30 minutes to one hour to make certain that you are doing well. When you are ready to be discharged, go home directly and rest. Have a responsible person stay with you the first twelve hours. Do not drive a motor vehicle for 24 hours after your procedure. If you have discomfort at the injection site, place a cold pack over the injection site for fifteen minutes every two hours for the first twelve hours.

After 24 hours any muscle tightness should be treated with a heating pad or by directing water from a hot shower to the area of soreness. You may have some return of your leg discomfort after the local anesthetic wears off which should resolve after the steroid medication starts to work. If you have continued pain, fever or leg weakness, call your Pain Management doctor. Please do not perform vigorous activity for one week. When you are feeling better, slowly increase your activity.