Transforaminal Epidural Steroid Injection

A transforaminal epidural steroid injection is a minimally invasive outpatient procedure in which a steroid-anesthetic medication is injected under x-ray guidance to reduce swelling and inflammation of irritated spinal nerves. The injection takes only a few minutes to complete.

These injections can be performed in the lumbar, cervical, or thoracic spine.

The lumbar procedure is performed to relieve lower back and leg pain related to nerve compression.

The cervical procedure is performed to relieve neck, shoulder, and arm pain related to nerve compression.

The thoracic procedure is performed to relieve upper back, ribs, and abdomen pain related to nerve compression.

The Procedure

The patient lies face down and x-rays are taken to locate the precise area where the inflammation is occurring. Medication is administered with a tiny needle to numb the area. Under x-ray guidance, a needle is positioned where the spinal nerves exit the openings. Contrast dye is used to verify correct placement.

The steroid medication is then injected around the spinal nerves that are causing pain and the needle is removed. Sometimes the injections are performed at multiple levels.


The risks of the procedure are bleeding, infection, and damage/irritation to nerves. These are mitigated by ensuring the patient is not on blood thinners and has received permission to stop them, there are no active infections, and the procedure is performed in a sterile manner by an experienced fellowship-trained physician under x-ray guidance for precision needle placement.


Immediate relief from numbing medication is often felt. It can take up to two weeks to receive the full benefit of the procedure. Depending on the condition and length of time the symptoms have been present, the benefits can last 3 months or much longer. The procedure can be repeated up to 4 times a year.