Lumbar Transforaminal Epidural Steroid Injection.

This procedure is performed to investigate and/or treat buttock and leg pain which has its origins in the irritation of a lumbar spinal nerve, usually as a consequence of a lumbar disc protrusion. The sharp shooting pains which extend from the lower back down the leg is called radicular pain and this is most amenable to the transforaminal epidural steroid injection. The deep aching pain extending from the lumbar spine down the leg is less likely to respond and back pain itself seldom responds.

It is important that the patient is not pregnant and if the patient is pregnant, they must inform the doctor before the procedure is commenced. The x-ray dose is within recommended limits for adults, but may be hazardous for a developing baby. It is important that you are accompanied by a friend or relative to drive you home after the procedure, as you may feel a little unsteady and so we advise you not to drive.

During the procedure you will lie face down on an x-ray table with the x-ray machine positioned over your lumbar spine. You will be awake for the procedure and will be able to listen and talk during the procedure. If for any reason you wish the procedure to stop, please let the doctor or radiologist know.

The area over the lower back is initially cleaned with antiseptic, a drape is then placed over this and a fine needle is then placed on your skin to check the position with the x-ray machine. Once the alignment is satisfactory, the needle is inserted which will give a slight stinging sensation, then an aching sensation as it passes towards the lumbar spine. Occasionally the needle will touch a spinal nerve which may produce an electric shock sensation. Once the needle is in place, a small amount of contrast is injected to make sure the needle is in place, then a test dose of local anaesthetic is given and a period of two minutes is waited to determine if the needle is in the correct position. If the needle is in the correct position the corticosteroid is then given, followed by a small quantity of local anaesthetic. Generally there is a pressure sensation when giving these doses. Sometimes there may be a slight unsteadiness of the leg following the procedure.

You will be asked to wait for at least half an hour following the procedure before being reassessed and allowed home. It is important that a responsible person drives you home.

It is asked that you make an appointment to see Dr McLaughlin approximately two weeks after the procedure for follow up. Please ring 03 337 4839 to do this.

There will be some discomfort in the lower back where the needle was placed, but this usually settles over 24 hours. Increasing back pain or increasing leg pain should be reported to Dr McLaughlin or his nurse. If Dr McLaughlin or his nurse cannot be contacted, contact should be made with your general practitioner and he or she should be made aware of the procedure that you have had, ie. a transforaminal lumbar epidural steroid injection. 

Risks of the procedure:

• Allergic reactions to local anaesthetic and anaesthetics can occur and you must tell the doctor before the procedure if you do have allergies.
• Occasionally patients may feel faint during the procedure and if this happens, please tell the doctor as the procedure could be interrupted or postponed.
• As the local anaesthetic can numb muscles and nerves, there may be an altered balance for 2-3 hours.
• Infection where the needle pierces the skin is a rare complication. If there was redness, tenderness or any concern about infection, please contact Dr McLaughlin. If he is not available contact should be made with your general practitioner.
• Occasionally following the block there may be an initial aggravation of your symptoms, but this should be short lived. We recommend that you do not undertake any strenuous activities for 3-5 days following the procedure.
• Spinal cord damage has been reported to occur very rarely as a complication of this procedure. Two safety techniques are used to avoid this. The use of contrast and then the use of local anaesthetic.

Questions

If you have any questions about the procedure, please contact Dr Mark McLaughlin or Margaret who does the bookings on 03 337 4839.

The procedures are completed at Southern Cross Radiology, 129 Bealey Ave, Christchurch.