A Transforaminal Epidural Steroid Injection (TFESI) is a minimally invasive procedure used to relieve nerve root pain in the spine — commonly known as radicular pain or sciatica. It involves precisely injecting anti-inflammatory medication and anesthetic into the epidural space near the affected nerve root through the neural foramen (the natural opening between vertebrae). TFESI both reduces inflammation and helps identify the exact source of nerve compression. This targeted approach can provide long-lasting pain relief and help avoid or delay surgery in many patients.
Indications
TFESI is typically recommended for patients with:
- Lumbar or cervical disc herniation causing nerve compression
- Foraminal stenosis (narrowing of the nerve exit canal)
- Postoperative radicular pain after previous spinal surgery
- Chronic low back or leg pain (sciatica)
- Diagnostic evaluation before surgical planning
The most common symptoms include radiating leg or arm pain, numbness, tingling, or burning following the nerve distribution.
Procedure
1. Preparation
- Performed in an outpatient setting under local anesthesia and fluoroscopic (X-ray) guidance.
- The patient lies face down on the procedure table.
- Skin is cleaned, sterilized, and a small amount of local anesthetic is applied for comfort.
2. Injection Technique
- Using fluoroscopy, a fine needle is advanced into the neural foramen near the irritated nerve root.
- A small amount of contrast dye is injected to confirm accurate needle placement and proper spread of medication.
- Then, a mixture of corticosteroid (to reduce inflammation) and local anesthetic (for immediate relief) is injected.
- The entire procedure usually takes 15–20 minutes, with minimal discomfort.
3. Post-Procedure
- Patients are monitored for a short period afterward and can usually walk and go home the same day.
- Temporary numbness or mild heaviness in the leg or arm may occur for a few hours due to the anesthetic effect.
Expected Benefits
- Pain relief: Reduction in leg or arm pain from nerve inflammation.
- Improved mobility: Allows participation in physiotherapy and daily activities.
- Diagnostic value: If pain relief is achieved, it confirms the targeted nerve as the pain source.
- Surgery postponement or avoidance: In some cases, TFESI can eliminate the need for immediate surgery.
The duration of pain relief varies — from weeks to several months, depending on the underlying cause and patient response.
Risks & Complications
TFESI is a safe procedure when performed by experienced specialists using image guidance, but potential risks include:
- Temporary increase in pain for 1–2 days
- Injection site soreness or bruising
- Dural puncture headache (rare)
- Allergic reaction to medication or contrast
- Infection or bleeding (extremely rare)
Serious complications are exceedingly uncommon with modern technique and sterile precautions.
Recovery & Follow-Up
- Rest for the first 12–24 hours after the injection is recommended.
- Most patients resume normal activities the following day.
- Pain relief may start immediately or gradually improve over several days as the steroid takes effect.
- If significant relief is achieved, physical therapy and back-strengthening exercises are started.
- Repeat injections may be considered if pain returns after weeks or months.
Additional Notes
In patients with multiple-level compression or postoperative pain, TFESI can be combined with other image-guided injections or physiotherapy for optimal results. If repeated injections provide only short-term relief, surgical decompression may be discussed as a definitive treatment option.
Patient Advisory
Every patient’s condition and pain source are unique. While TFESI is highly effective for many, it may not benefit all cases equally. The decision to perform the injection — and its frequency — must be made by your treating neurosurgeon or pain specialist after thorough evaluation. Do not rely on online information to self-diagnose or choose treatment.