Transforaminal Epidural Steroid Injection

A transforaminal epidural steroid injection (TFESI) is an injection of corticosteroids (similar to cortisone) into the space just outside the covering (the dura) of the spinal cord in your lower back. Because the injection is outside (epi) the dura, it is called an epidural injection. A transforaminal epidural steroid injection may be performed at a single level or at multiple levels.


What are the indications for a transforaminal epidural steroid injection?

These injections are performed when it is thought that a specific spinal nerve (or nerves) is part of the process that is causing the pain. Common indications for TFESI include herniated discs, radiculopathy, or radiculitis.

How do transforaminal epidural steroid injections work to control my pain?

The spinal cord travels from the brain to the waist in a tunnel in the back part of the spine. About every inch along the way, the spinal cord gives off branches (spinal nerves) to the right and left. These spinal nerves carry sensations and pain signals from the various parts of the body back to the brain. Corticosteroids are very potent anti-inflammatory medications that work best when they are injected into the area where the inflammation is occurring. A TFESI allows the medication (steroid) to come into direct contact with the inflamed spinal nerve(s), reducing the pain associated with the inflammation.


What should I expect during the procedure?

A local anesthetic will then be injected into your skin to make it numb. The specially designed needle will then be inserted through the numbed skin and slowly advanced into the specific foramen using fluoroscopy (live X-rays) to guide the needle. Once the needle is in the proper location, a small amount of contrast will be injected under live X-ray to ensure that the medication will spread properly. After this, the corticosteroid will be slowly injected into the epidural space. Once the injection is complete, the needle will be withdrawn and a dressing will be placed over the injection site.


What can I expect after the procedure?

Your blood pressure, pulse, and breathing will be checked frequently over the next 15 to 20 minutes. Once your vital signs are stable, you will be able to go home. Some patients will experience immediate relief, however, it usually takes 24 to 72 hours for the effects of the steroid medication to take effect and it may be up to 1 week before the maximum benefits are achieved. Very often more than 1 injection is necessary to achieve a good level of pain relief.

Common Conditions Treated by Transforaminal Epidural Steroid Injections