Lumbar Transforaminal Epidural Steroid Injection

You will need a physical exam to be sure you are in good health. Sometimes, depending upon your medical history, you may need a blood test, electrocardiogram (EKG), and chest X-ray. Discuss all medications (prescription, over-the-counter, and herbal supplements) you are taking with your health care provider. Some medications need to be continued or stopped the day of surgery.

Medications that thin the blood should be stopped prior to surgery. Your Internist or primary doctor should be consulted prior to changing or discontinuing any medications. Also, stop drinking alcohol 1 week before and 2 weeks after surgery because these activities can cause bleeding problems. An important thing you can do to ensure the success of your spinal surgery is to quit smoking. This includes cigarettes, cigars, pipes, chewing tobacco, and smokeless tobacco. Nicotine prevents bone growth and puts you at higher risk for a failed fusion.

Morning of surgery

• Shower using antibacterial soap. Dress in freshly washed, loose-fitting clothing.
• Wear flat-heeled shoes with closed backs.
• If you have instructions to take regular medication the morning of surgery, do so with small sips of water.
• Remove make-up, hairpins, contacts, body piercings, nail polish, etc.
• Leave all valuables and jewelry at home (including wedding bands).
• Bring a list of medications (prescriptions, over-the-counter, and herbal supplements) with dosages and the times of day usually taken.
• If you have a cold, fever or some other illness the day before surgery, please call your surgeons office.
• Bring a list of allergies to medication or foods.

The patient lies face down. A cushion is placed under the stomach area to provide comfort and flex the back. This position causes the spine to open, allowing for easier access to the epidural space. The physician uses a fluoroscope to locate the appropriate lumbar vertebra and nerve root and a local anesthetic numbs the skin. All of the tissue down to the surface of the vertebral transverse process is anesthetized.

The physician slides a thin, bent needle with a slightly curved point through the anesthetized track. With the aid of the fluoroscope, the physician carefully glides the needle into the foraminal space near the nerve root. The physician injects a contrast solution and uses the fluoroscope to see the painful areas and confirm the correct location of the needle tip. A steroid-anesthetics mix is injected into the foraminal epidural space, bathing the painful nerve root with soothing medication.

The needle is removed and a small band-aid is used to cover the tiny needle surface wound. In some cases it may be necessary to repeat the procedure to provide the full benefit of the medication. However many patients feel significant relief from only one or two injections.

Patients are typically allowed to go home 30 minutes or so after the injection. It is recommended to have a ride available to help you home. You may remove your surgical band-aid later that day and shower if desired. Different patients will have varied amounts of relief from the injection. It is important to keep track of what happens to your pain after the injection until you follow up with your physician.

In general, the injections help most patients to some degree. Each individual can have varied results. Medical literature indicates that about half of those treated will not need more than an injection and functional rehabilitation to obtain satisfactory results. Other patients unfortunately, may require more invasive treatments.