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Transforaminal Epidural

Transforaminal Epidural an image-guided interventional procedure where steroids or other medicines are injected inside the neural foramen of the spine.

What is a transforaminal epidural?

Transforaminal Epidural an image-guided interventional procedure where steroids or other medicines are injected inside the neural foramen of the spine.

This is an image-guided interventional procedure where steroids or other medicines are injected inside the neural foramen of the spine. This procedure is called a transforaminal epidural, nerve root block, or transforaminal epidural steroid injection. This is a similar procedure to epidurals, but here the epidural space is accessed through the neural foramen.

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Anatomy

Our spine has several small pieces of bones and there is a canal inside. This is called the spinal canal. The spinal cord starts from the brainstem and passes through this spinal canal. The spinal canal has several openings on either side and these are called neural foramen.

The nerve roots which start from the spinal cord come out of the spinal canal through these neural foramina and are distributed throughout our body as peripheral nerves.

These neural foramina are connected with the epidural space around the spinal cord. So, if any medicines are injected in the neural foramen bath the nerve roots first and then go into the epidural space if large volumes are injected.

Indications

Inflammation of nerve roots because of a slipped disc or prolapsed disc is the best indication for a transforaminal epidural. But it is also indicated in the following conditions:

  • Acute herpes zoster or post herpetic neuralgia
  • Lateral canal stenosis
  • As diagnostic procedure as a selective nerve root block
  • Post laminectomy syndrome

Procedure

The transforaminal epidural is a potentially dangerous procedure and is always done under real-time image guidance like C-arm or fluoroscopy guidance. Sometimes it is also done under ultrasound guidance. The steroid is the most common medicine used in transforaminal epidural and that is why this procedure is also called a transforaminal epidural steroid injection. The most common medicine injected are triamcinolone, methylprednisolone, dexamethasone, or betamethasone. Other than these steroids, dyes like iohexol, normal saline, hyaluronidase and local anesthetic drugs  are also injected in specific indications.

Complications

Though these complications extremely rare in expert hands. The complications are:

  • Nerve root injury is possible but not that common. This can be easily avoided by doing the procedure without general anaesthesia or deep sedation.
  • Injection of a particulate steroid into the blood vessels is a potentially dangerous complication but avoided by performing the procedure under C-arm with dye/contrast confirmation.
  • Infection is a rare possibility as the procedure is done at the operation theatre under sterile conditions.

 

Other side effects like pain at the injection site, muscle spasms, transient numbness, or weakness are common and are temporary. As a whole, the transforaminal epidural is a very useful procedure for radicular pain and sciatica and it is also a frequently done procedure by pain physicians.

FAQ’s
The transforaminal epidural is a potentially dangerous procedure and is always done under real-time image guidance like C-arm or fluoroscopy guidance. Sometimes it is also done under ultrasound guidance. It must be done by expert physicians who are well trained in performing interventional pain management procedures.
The steroid is the most common medicine used in transforaminal epidural and that is why this procedure is also called a transforaminal epidural steroid injection. The most common medicine injected are triamcinolone, methylprednisolone, dexamethasone, or betamethasone. Other than these steroids, dyes like iohexol, normal saline, and hyaluronidase are also injected in specific indications.
In conditions like failed back surgery syndrome, there are adhesions around the nerve root which causes symptoms. In transforaminal neuroplasty, these adhesions are broken down with the help of special catheters and after breaking adhesions, a steroid is injected.
There several possible complications. Though these complications extremely rare in expert hands. The complications are:
  • Nerve root injury is possible but not that common. This can be easily avoided by doing the procedure without general anesthesia or deep sedation. If the physician touches the nerve root, there will be complaints of unpleasant paraesthesia and won’t allow proceeding further.
  • Injection of a particulate steroid into the blood vessels is a potentially dangerous complication but avoided by performing the procedure under C-arm with dye/contrast confirmation.
  • Infection is a rare possibility as the procedure is done at the operation theatre under sterile conditions.

Other side effects like pain at the injection site, muscle spasms, transient numbness, or weakness are common and are temporary. As a whole, the transforaminal epidural is a very useful procedure for radicular pain and sciatica and it is also a frequently done procedure by pain physicians. But this procedure must be done by experienced and best doctors for back pain treatment.
Patients visit our practice from all over India and abroad due to our unique approach and extensive medical offerings. Note: A Medical examination is required to diagnose and treat any & all medical conditions. This site’s information is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment.
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