Transforaminal Epidural Steroid Injection

What is Transforaminal Epidural Steroid Injection?

The epidural space of the spine is the area between the vertebral bones and the protective dura sac that surrounds the spinal cord and nerves.

A steroid injection consists of an anti-inflammatory medication called a corticosteroid, that is combined with an anesthetic and injected into the body to relieve pain and inflammation.

A transforaminal epidural steroid injection is a minimally invasive procedure where medication is injected into the opening at the side of the spine where the nerve roots exit, called the foramen.

It is useful for treating the pain associated with the back, neck, arms or legs by reducing inflammation of the spinal nerves caused by disc herniation or spinal stenosis.


A transforaminal epidural steroid injection is indicated for people suffering from the following conditions:
  • Degenerative Disc
  • Herniated Disc
  • Spinal Stenosis
  • Sciatica
  • Spondylolisthesis

What are the Contraindications of Transforaminal Epidural Steroid Injections?

Transforaminal epidural steroid injections are contraindicated under the following conditions:

  • If you have bleeding problems or
  • infection is present

Care should be taken for the following people:

  • Diabetics
  • People on blood-thinning medications
  • High blood pressure (hypertensive) patients
  • Patients with glaucoma
  • Pregnant women, as it may be detrimental to the baby

Preparation for a Transforaminal Epidural Steroid Injection

A transforaminal epidural steroid injection is usually performed as an outpatient procedure using a live x-ray called fluoroscopy.

You will be asked to:

  • Sign consent forms
  • List your current medications
  • List allergies to any medications

The entire procedure lasts about 15-45 minutes.

Your doctor will inject the medication as close to the painful nerve as possible to provide the best results.

How is the Transforaminal Epidural Steroid Injection Introduced?

Administering a transforaminal epidural steroid injection involves three steps:

Step 1: Patient Preparation

You will lie on an x-ray table on your stomach. A local anesthetic will be used to numb the treatment area to keep you comfortable.

You will be kept awake during the procedure but may be given a sedative to put you at ease if needed.

Step 2: Needle Insertion

Your doctor inserts a hollow needle through the skin into the epidural space between the bony vertebrae with the help of live x-ray images from fluoroscopy. You may feel slight pressure or pain.

Step 3: Injecting the Medication

After ensuring the needle is in the correct position, the corticosteroid and anesthetic combination is injected into the epidural space around the nerve roots. The needle is then removed and a small dressing placed over the insertion site.

The procedure may be repeated in other spinal regions depending on the location of your pain.

What is Post-Injection care?

After you have received a transforaminal epidural steroid injection, you should be able to walk around immediately, however, some people may find it difficult right away. You will be monitored in the recovery room for any adverse reactions for a short period of time and later discharged.

  • You should have someone drive you home after the injection procedure.
  • You may be prescribed pain relievers and ice to relieve soreness around the injection site.
  • You should be able to resume full activity the next day.
  • If you feel increasing discomfort or pain, you should contact your physician immediately.

What is the Risks and Complications of Transforaminal Epidural Steroid Injection?

Transforaminal epidural steroid injections are a relatively safe, non-surgical treatment. However, puncture of the dura sac may occur during needle insertion and can cause:

  • Spinal bleeding
  • Infection
  • In rare cases, nerve damage/ paralysis

Corticosteroid medication may cause:

  • Water retention
  • Weight gain
  • Mood swing
  • Hot flashes (Flushing)
  • Insomnia
  • Elevated blood sugar levels in diabetics

Minor side effects include muscle weakness or numbness that usually resolves within 8 hours in the affected leg or arm.

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Melinda Bess
Melinda Bess
Dr. Iqbal is the best pain management doctor I have ever had and will have. She does her homework first which I think makes the difference in diagnosis. She is the total package, a very smart and beautiful doctor, wife, and mother. Hand on Bible she changed my life, and I will forever be in debt to her. I can't say thank you enough. I appreciate her staff; they are all awesome as well. I laughed and cried in her office, but her smile and staff always made me feel welcome like part of their family. I would and will drive across country to see her. The referral to a new knee surgeon to fix a bad knee replacement was the best. I got a new knee, and it has been a huge blessing as well. Thank you, Dr. Iqbal and staff you all are 5 stars, in my life.
Nikin Mehta
Nikin Mehta
Brian Knopf
Brian Knopf
Dr. Iqbal and her staff are fantastic! I couldn’t have asked for a better experience. I highly recommend her and her team
Brenda Jones
Brenda Jones
I visited this facility in January for severe back pain I was experiencing. The whole ordeal from beginning to end was amazing. I wish I had known about this place years ago before suffering from so much pain. Dr. Mehreen Iqbal, her assistant Michealle Dooley and their staff is the best. I had a procedure done on 1/17/24 and I no longer suffer from back pain and I'm able to walk again. I highly recommend this facility, 10 Stars!!!
Ann Adkins
Ann Adkins
Wonderful experience with Dr. Iqbal & her staff! She is amazing! She listens to her patients & immediately developed a plan to address my back & neck pain. I already feel SO much better and am confident that her plan for me will mean continued improvement. Her staff is wonderful too - friendly, helpful & responsive. I highly recommend Dr. Iqbal & her team!
Camille Adams
Camille Adams
The staff are very kind and helpful, and Dr. Iqbal is very good at what she does. Would recommend to all my friends and family.
Noor Malik
Noor Malik
My PCP recommended Dr. Mehreen and she was wonderful through out the entire injection process. She took her time explaining everything and was patient through out the process. In my opinion, she is the best pain management doc around.
Jessie Wilson
Jessie Wilson
I love Dr. Iqbal and her staff, I couldn't be any luckier to have found her practice. Dr. Iqbal listens well and explains in detail any procedures. She is honest, caring, and down to earth. She and her staff are the greatest. I would recommend her to any of my friends or family.
Shimmerynight Skies
Shimmerynight Skies
My mother is a patient here and the staff is super nice, fun, and sweet! I highly recommend coming here for friendly service
Excellent doctor. Dr. Iqbal explained every thing in detail and laid out a very clear plant to treat the problem/pain.