Transforaminal Epidural Injections for Lumbar Radiculopathy
Low back pain is one of the most challenging musculoskeletal problems for pain management specialists. Radiculopathy is a syndrome that occurs when back nerves are irritated or inflamed. It is associated with arm or leg symptoms, such as radiating pain, weakness, and numbness. An effective treatment option for patients with lumbar radiculopathy is the transforaminal epidural injection.
What does ‘transforaminal’ mean?
The medical term ‘transforaminal’ refers to the positioning of the needle along the spinal column. The foramen is the bony hollow archway of the vertebrae, created by protrusions that create a passageway. Spinal nerves run through the passage way as they branch from the spine cord. The spine nerves exit through the foramen and travel to muscles, organs, and sensory body structures. Transforaminal injection is where the needle is inserted into the foramen opening at the side.
What causes lumbar radiculopathy?
For many people, lumbar radiculopathy occurs secondary to a herniated disc or spinal stenosis. The spinal nerve(s) become impinged (compressed) due to crowding of the passageway. The disc loose normal height due to water content loss, and the bony projections protrude out of alignment, compressing spinal nerves.
How common is lumbar radiculopathy?
According to a recent prevalence study, lumbar radiculopathy is a common disorder seen by neurologist. It affects around 4% of the general population, and is most common among people 40-60 years of age. Based on the findings of this study, men and women are affected equally by lumbar radiculopathy.
Is the transforaminal epidural injection effective?
In a recent study evaluating patients who had transformainal steroid epidural injections, researchers found a 90% success rate for symptom and pain relief. The advantage of this approach over the conventional technique is the correct positioning of the needle and accurate delivery of medication to the targeted nerve.
How long does pain relief last with this procedure?
According to a recent clinical study, patients enjoyed symptom relief that lasted from 3-6 months. However, another research group found that long-term effects of the transforaminal epidural injection lasted for up to 20 months for 76% of patients.
How is the procedure done?
When you arrive at the surgical center, a nurse has you change into a procedure gown and places an IV catheter in your arm. A sedative is given to keep you comfortable. After being positioned on the table, the doctor cleans the back and numbs the skin using an anesthetic. The procedure needle is inserted into the epidural space using x-ray guidance. After injecting the medication, the needle is removed, and a bandage is applied.
Are there any specific preparations for the procedure?
Before undergoing a transforaminal epidural injection, you need to notify the doctor of all medications you take. Certain blood-thinning drugs must be held several days before your procedure. The doctor will discuss the risks and benefits and have you sign a consent form. Notify the pain specialist if you have any health conditions, such as heart disease or diabetes.
What activity limitations need to be considered?
After the epidural steroid injection, you should rest for the remainder of the day. We recommend that you gradually return to usual activities as tolerated. Most people take 2-3 days off from work before going back.
Resources
Lee JW, Kim SH, Choi JY, Yeom JS, Kim KJ, Chung SK, et al. (2006). Transforaminal epidural steroid injection for lumbosacral radiculopathy: preganglionic versus conventional approach. Korean J Radiol, 7.
Ridley MG, Kingsley GH, Gibson T, & Grahame R (1988). Outpatient lumbar epidural corticosteroid injection in the management of sciatica. Br J Rheumatol, 27:295–299
Sung MS (2006). Epidural Steroid Injection for Lumbosacral Radiculopathy. Korean J Radio, 7(2), 77-79.
Tarulli AW & Raynor EM (2007). Lumbosacral radiculopathy. Neurol Clin, 5(2), 387-405.