Transforaminal Epidural Steroid Injections


Your doctor will provide you with more detailed information if an ESI is being recommended for you.


Spine Anatomy


Vertebrae: Your spine is made of ring-shaped bones called vertebrae.

Spinal column: The “rings” at the center of each vertebrae line up to form a column in your back (the spinal column).

Spinal cord: The spinal cord extends from the base of the brain and ends at the upper lumbar spine, continuing further down as a large bundle of nerves through the lower the spinal column.

Dura mater: A membrane called the dura mater covers and protects the spinal cord.

Epidural space: There is a small space surrounding the dura mater called the epidural space.

Nerve roots: Branches of nerves from the spinal column (nerve roots) pass through the spinal canal and extend into the back, arms, and legs. If something is irritating the nerve roots (such as an abnormality in one of the vertebrae or discs), pain can be felt in the back and all along the nerve.


What is ESI?

ESI is an outpatient procedure in which the doctor injects a steroid (an anti-inflammatory medicine) into a very precise area of the epidural space, using X-ray guidance (fluoroscopy).


What are the benefits?


Reduces inflammation. The medicine is used to reduce any inflammation that may be present in a spinal nerve root.

Relieves pain. ESI relieves pain in the arms and legs caused by an irritated nerve root.

Helps determine cause of symptoms. ESI is useful in both the diagnosis and treatment of certain spine conditions. By placing the medicine in a precise area and monitoring the patient’s response, valuable information is gained about what nerves may or may not be involved in causing the symptoms and how to target appropriate treatment.


What are the advantages of transforaminal ESI?


May increase success in reducing pain. The main advantage of transforaminal ESI is that the doctor can deliver the medicine into the neural foramen that contains the actual nerve root in question, which can increase the likelihood of success in reducing the patient’s pain.

Helps ensure focus on the correct nerves. Another advantage is that the doctor can inject lidocaine – a numbing medicine – which works immediately (but temporarily) to numb the nerve root. If the numbing medicine immediately relieves the patient’s pain, the physician then knows that the correct area has been reached. This can help ensure that steroid injections or surgery that will be done are focusing on the correct nerves.


What are some considerations?


Spine injections should only be done by doctors with special training. Before the ESI procedure, the doctor will get detailed pictures of the spine using MRI or CT scan, which will help determine the best approach.


What happens during the procedure?


  1. The patient lies face down on a table.
  2. Numbing medicine is injected into the back.
  3. Contrast dye is injected into the area so that the structures will be visible on X-ray.
  4. Using X-ray guidance, the doctor then places the steroid medication into the precise area believed to be causing the problem.

The procedure takes about 15 minutes. The patient is then observed for 20-30 minutes before going home. The arms or legs can be weak for a brief time after the procedure because of the numbing medicine, so patients are asked not to drive themselves home and to take care when moving about for the rest of the day.

Patients may have slight discomfort for a few days after the procedure, before they begin to feel the benefits of pain relief.


Does ESI work? For how long?


Provides pain relief for many. Many patients who undergo ESI have a significant decrease in arm or leg pain.

Usually lasts about 6-12 weeks. It can take a few days for the effects to be known. If the pain gets better, the effects usually last about 6-12 weeks.

If needed, the procedure can be repeated. Patients who do get better may not get complete relief of their pain. A realistic goal is to achieve a major reduction in the level of pain.


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Not intended as medical advice. Please consult a physician for all medical issues.