Transforaminal Epidural Steroid Injections

What is a Transforaminal Epidural Steroid Injection?

A transforaminal epidural steroid injection (TFESI) is an injection of corticosteroids 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 Once the injection is complete, the needle will be withdrawn, and a dressing will be placed over the injection site.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 are the risks and side effects?

The complication rate for this procedure is very low. Whenever a needle enters the skin, bleeding or infection can occur. If the bleeding accumulates inside the body, it forms a hematoma. If the hematoma pushes against structures of the spine, surgery may be required to evacuate it. Another potential complication is a “spinal headache”, which can occur when attempting an ESI. If this occurs, it usually resolves on its own within three to five days. Alternately, there is another procedure that can be performed to cure the headache within a matter of minutes. Some other serious but extremely rare risks include paralysis and death.

You may have an allergic reaction to any of the medications used. If you have a known allergy to any medications, especially x-ray contrast dye or local anesthetics, notify our staff before the procedure takes place.

How long does it take for the procedure to work?

The steroid medication begins to take effect in one to two days at which point you should start to see some benefit. The steroid effect continues to get stronger and stronger such that the peak effect occurs at about two weeks. Thereafter, the effect will stabilize and should last several weeks to months. Typically, the pain relief experienced from this procedure lasts 3-6 months, but there is significant variability from patient to patient and from one procedure to another. When the pain starts to return, this procedure can be repeated to try and attain some pain relief once again. Keep in mind that this injection may work very well for pain certain areas but may not help with others. This is normal. Areas of pain that do not respond may need other treatments, which you can discuss with your doctor.

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