Epidural and Foraminal Injections in Sharjah
Medically reviewed by Dar Al Kamal Team
What are epidural and foraminal injections?
Epidural and foraminal injections deliver medicine to the nerve roots of the spine rather than to the disc itself. The epidural space is a thin cushion of fat and blood vessels just inside the spinal canal, wrapped around the sac that holds the spinal nerves. The foramen is the small side window between two vertebrae through which a single nerve root leaves the spine on its way to the limb.
There are three common routes. An interlaminar injection enters the epidural space from behind, between two vertebrae, and bathes several roots at that level. A transforaminal, or foraminal, injection approaches from the side and places the medicine right at the exit point of one named root. A caudal injection enters low down, near the tailbone, and lets the medicine rise into the lower lumbar levels.
The mixture is usually a corticosteroid, which damps the chemical inflammation that leaking disc material causes around a root, and a local anaesthetic, which numbs the root for a few hours. A detail patients rarely expect: the two parts work on different clocks. The anaesthetic acts within minutes and fades the same day, while the steroid builds over the following days.
At Dar Al Kamal Hospital, Sharjah, these injections are part of the spinal pain service in the Neurosurgery department. They are one of several needle-based options; others aim at the disc itself, such as ozone therapy for disc herniation and radiofrequency therapy.
Who needs it
An epidural or foraminal injection suits adults whose main problem is root pain: burning or electric pain travelling down a leg or arm, often with tingling, from a herniated disc or from narrowing of the foramen. It usually follows a period of the stepwise care set out on herniated disc treatment, once the leg pain remains strong enough to stop walking, sleep or exercise. Leg pain from the lower back is described in more detail on sciatica treatment.
The injection also answers a question. When the neurosurgeon numbs one chosen root and the familiar leg pain quietens, that response helps confirm which level is responsible, which is useful when an MRI shows changes at more than one disc. This targeted version is often called a selective nerve root block.
For many people the aim is a window of calmer pain in which exercise and normal activity can restart.
What happens
You lie face down on a padded table, or on your side for a neck injection. The skin over the chosen level is cleaned, and a small injection of local anaesthetic numbs it first.
The neurosurgeon then guides a fine needle towards the target while watching live X-ray images, so the tip can be placed at the correct level and side. A small amount of contrast dye is injected to show on the screen how the fluid spreads along the root. Once the pattern looks right, the medicine is injected slowly.
During a foraminal injection, many people feel a brief echo of their usual leg pain as the fluid reaches the root. That sensation is expected; it tells the doctor the medicine is sitting where it should, and you can say so as it happens. You then rest for a short spell while the nurses check your blood pressure and how your legs feel.
Preparing for it
Bring your MRI images and report, and a list of every medicine you take. Blood thinners need a plan agreed with the prescribing doctor in advance, because they change the bleeding risk near the spine. If you have diabetes, bring your glucose meter, since the steroid can push blood sugar up for a few days.
Tell the team if you are allergic to contrast dye, iodine or local anaesthetic, if you may be pregnant, or if you have a fever or an infection. Wear loose clothes, eat a light meal unless told otherwise, and arrange a lift home, since the leg can feel heavy or numb for some hours.
Afterwards
Keep a simple pain diary. Note your pain on the day, when the anaesthetic is active, and again over the following week or two as the steroid takes effect. This record shows the neurosurgeon both whether the right root was targeted and how much the inflammation settled, which guides the next step.
Take it easy for the rest of the day and resume normal walking the next day. Keep the small plaster dry overnight; in the Sharjah heat, a cool shower the following day is fine. Check your blood sugar more often if you have diabetes. During Ramadan, ask the team how to fit the injection and any tablets around fasting hours.
Contact the hospital if the injection site becomes red, hot or swollen, if you develop a fever, or if a headache appears that is worse when you sit or stand and eases when you lie flat. **Go to the emergency department straight away if you develop new weakness in a leg, numbness around the groin or inner thighs, or any change in bladder or bowel control.**
Cost and insurance
Most UAE insurance plans cover a spinal injection when it is medically indicated, and nearly all require pre-approval supported by the MRI report and notes of the treatment already tried. Some plans set a limit on the number of injections per year. Dar Al Kamal Hospital, Sharjah can help you check your cover on 06 599 7777.
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Frequently asked questions
What are the risks of an epidural or foraminal injection?
An epidural or foraminal injection carries small risks of infection, bleeding, a temporary rise in blood sugar, facial flushing, and a headache if the needle punctures the membrane around the nerves. Rarely, the injection can injure a nerve or a blood vessel. The neurosurgeon explains how these risks apply to you, including any added risk from blood thinners, before you agree.
How long does the relief from an epidural steroid injection last?
The relief from an epidural steroid injection varies widely from person to person. Some people have little change, others have relief that lasts long enough for the disc to settle naturally, and others need a further injection. The injection reduces inflammation around the nerve and leaves the herniated disc in place, so it may ease pain without changing the disc on a later scan.
What is the difference between an epidural and a transforaminal injection?
An epidural injection given between the vertebrae from behind spreads medicine around several nerve roots at one level, while a transforaminal, or foraminal, injection places it at the side opening where one specific root leaves the spine. The neurosurgeon chooses the route according to where your pain travels and what the MRI shows.
Is an epidural injection for back pain the same as an epidural in labour?
An epidural injection for spinal pain uses the same space in the spine as a labour epidural, but it is a single dose of steroid and anaesthetic given under X-ray, with no tube left in place. You can usually walk normally within a short time, whereas a labour epidural keeps the lower body numb throughout.
How many epidural injections can I have?
The number of epidural injections is limited because repeated steroid doses affect blood sugar, bone and the body's own hormone balance. The neurosurgeon spaces them out and reviews your pain diary before offering another, and if two well-placed injections have given little lasting benefit, other options are usually discussed.
Can I drive after an epidural or foraminal injection?
You should not drive yourself home after an epidural or foraminal injection, because the local anaesthetic can make the leg heavy or numb for some hours. Most people can drive again the next day once feeling and strength are normal.
Does an epidural injection hurt?
An epidural injection usually feels like a sting from the numbing injection, then pressure as the fine needle is placed. A foraminal injection often brings a brief burst of your familiar leg pain as the medicine reaches the nerve root, which settles quickly.
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