Transforaminal Injections in Northern New Jersey

When a patient has a condition such as sciatica or a herniated disc, they may experience chronic pain in their lower back that radiates into the legs and feet. At the Centers for Neurosurgery, Spine & Orthopedics (CNSO), the medical team offers several types of opiate-free options for pain management, including transforaminal injection treatments. Located in Northern New Jersey, with multiple office locations, multiple surgical center and hospital affiliations, CNSO serves patients throughout the surrounding area where they want to be treated. 

What Is a Transforaminal Injection?

A transforaminal injection delivers a small amount of medication to a precise location where there is a pinched nerve. The opening at the top and bottom of each spinal vertebra where a nerve root branches off the spinal cord and exits the spinal column can sometimes become too small causing the nerve to be pinched. This opening that should freely allow the nerve to pass through is called the foramina. Sometimes referred to as a selective nerve block, a transforaminal injection can be used to block back pain caused by conditions such as:

• Sciatica: This is the term used when pain radiates along the sciatic nerve. It can be caused by several different conditions. As the largest nerve in the body, the sciatic nerve passes through the buttocks and along the back of the thigh, all the way down to the sole of the foot.
• Bulging or herniated discs: When a joint between the spinal bones is damaged, the disc joints can shift and press on the adjacent nerves, leading to chronic back pain.
• Degenerative disc disease: A common form of arthritis, this condition can happen when spinal joints lose their elasticity, leading to painful spinal compression.
• Radiculopathy: Commonly caused by a pinched nerve, radiculopathy is pain, numbness, weakness or tingling caused by a compressed nerve root.
• Spinal stenosis: This condition occurs when part of the spinal canal narrows, often because of injury or arthritis, putting pressure on the spinal cord. It is common among older adults but can vary in severity.

These injections also can be effective in treating patients with back pain from an injury such as a fall or a car accident. For safety, the procedure is performed using fluoroscopy (X-ray) guidance to ensure the steroid and anesthetic medications are being delivered to the correct location.

Procedure and Recovery

Before a patient has a transforaminal injection, they may need to stop using certain medications, such as blood thinners. A primary care physician can advise on which medications are safe and which should be avoided before the procedure. Female patients may need to take a pregnancy test, as exposure to X-rays can cause birth defects. Patients often need to refrain from eating or drinking before their appointment.

The entire procedure usually takes no more than 30 minutes. General sedation is an option if the patient requests it. A local anesthetic is used to numb the patient’s skin. With the help of X-ray guidance, a doctor will insert a needle into the patient’s lower back. They will administer a mixture of anesthetic and steroid medication at the site of the nerve root. The anesthetic provides temporary pain relief, while the steroid offers longer-term relief.

After the procedure, a small Band-Aid is applied at the injection site and the patient is sent to a recovery area for observation. They usually are discharged within an hour and will need a friend or family member to drive them home. The patient can return to work or school the next day but should refrain from driving a vehicle for 24 hours after their procedure. Any side effects of the treatment, such as dizziness or headaches, usually are minor.

Some patients experience pain relief immediately after the injection treatment; however, their pain may return after the anesthetic wears off but then reduced as the steroids being to take effect. It is normal for there to be several days before the patient feels the effect of the steroid medication. While each patient is different, one injection treatment can be sufficient to provide several months of pain relief.

What Next Steps Might a Physician Recommend?

If a patient responds well to transforaminal injection treatment, they can continue to have periodic transforaminal injections to minimize their pain but no more than 3-4 a year and for only one year. Injection treatments also can be helpful as a complementary treatment to structured physical therapy because they allow a patient to perform exercises and stretches without pain. If symptoms continue, then the cause of the pinched nerve will need to be addressed by a neurosurgeon or orthopedic spine surgeon. 

• Spine surgery: If a bone or disc is pressing on the nerves of the spinal cord, surgical procedures, such as a laminectomy or discectomy, can relieve pressure on the affected nerve.

If there are no radiculopathy symptoms, other treatment options for chronic lower back pain can include:

• Medial branch block: This type of injection treatment for axial back pain temporarily blocks the pain signals emitting from the medial nerves in the facet joints of the spine. This block is also referred to as a facet joint injection or block
• Radiofrequency Ablation (RFA): If the medial branch block eliminates the back pain for weeks or months, then the pain should also be eliminated if a second MBB becomes necessary. If the same back pain returns a third time, the medial branch nerve can be burned so it no longer causes pain.
• Basivertebral nerve ablation: This minimally invasive procedure uses radiofrequency energy to destroy a small portion of the basivertebral nerve ending, located in the vertebral body. The procedure prevents the nerve from sending pain signals to the brain.

Expertise in Pain Management

CNSO takes a holistic approach to determining the cause of pain, pain control techniques first without and only, if necessary, with opiates or marijuana, and supporting patients with an experienced team of board-certified pain management doctors, nurses, physical therapists, neurosurgeons, and orthopedic spine surgeons. The pain control doctors take the time to get to know each patient individually and determine the best course of action to treat their back or spine condition given their other medical conditions, support groups, and lifestyle. CNSO’s doctors strive to use the most conservative treatment options possible, recommending surgery only when it is absolutely necessary.

Schedule an Appointment Today

The dedicated team at the Centers for Neurosurgery, Spine, and Orthopedics (CNSO) understands how pain can impact daily life. Persistent lower back pain does not have to be a daily challenge. With expertise in noninvasive pain management treatment options such as transforaminal injections, patients can find significant pain relief from the team at CNSO. As one of NJ’s most comprehensive spine care centers, CNSO has multiple locations throughout Northern New Jersey and offers convenient telemedicine appointments. To serve a broader population of patients, CNSO’s award-winning medical team is fluent in:

• English
• Spanish
• Korean
• Mandarin Chinese
• Russian
• Serbo-Croatian
• Portuguese

To learn more about CNSO’s services or schedule a visit, contact us today.