Transforaminal Epidural Steroid Injection (Cervical, Thoracic, Lumbar)

Overview & Procedure 

A transforaminal epidural steroid injection (TFESI) is a minimally invasive procedure that can help relieve back and leg pain caused by inflamed, irritated spinal nerves. TFESIs may be performed to relieve pain caused by spinal stenosis, spondylolysis, or disc protrusion/herniation. Medicines are administered to the irritated spinal nerves through the opening (foramen) where the nerves exit the spine. The effects of the TFESI tend to be temporary but typically last 3-6 months. The goal is to reduce pain so patients may resume normal activities and a physical therapy program. 

Fluoroscopy (video X-ray) is used to improve safety and accuracy when guiding the needle into the narrowed foramen. Patients can remain awake for the entire process and the ability to report any discomfort makes the procedure safer. Light sedatives can be given to lessen anxiety but need to be arranged before the day of the procedure. During the procedure, the patient will lie on their stomach on the fluoroscopy (video X-ray) table. The back/neck will be prepped with a sterile solution and, using a video X-ray the appropriate vertebrae level will be located. The doctor will numb the area with local anesthetic. The patient will then feel pressure as the needle is advanced into the epidural space through the neuroforamen. During and/or after the injection the patient may feel pressure in their back/neck and down the leg/arm. The needle is then removed, and a band-aid is placed over the site.  

After Care 

Immediately after the procedure, patients are sent to a separate room to recover. During this time, the patient’s vitals are monitored for any signs of an adverse reaction. Most patients can walk around immediately after the procedure; however, some patients may experience temporary numbness or weakness. After being monitored for a short time, patients can usually leave and drive themselves home. If this is a patient's first injection, or the doctor plans to use a local anesthetic in the injection for diagnostic purposes, the patient must have someone else drive them home. If the area is sore apply ice to the back for 10-15 minutes every half hour for the remainder of the day. Patients should report any signs of a fever, infection, redness, swelling, and increased pain to their Southwest Spine and Pain  Center physician immediately.