FACT SHEETS
Transforaminal Epidural Steroid Injection (TFESI)
Transforaminal epidural injections are diagnostic and/or therapeutic procedures for pain originating from specific spinal nerve roots and surrounding structures. The procedure consists of injecting local anesthetic and anti-inflammatory medication (usually a corticosteroid) into the epidural space through the neural foramen, the opening where nerve roots exit the spine.
If the patient experiences significant pain relief while the medication is active, this suggests that inflammation around the specific nerve root is the source of pain. This confirms the diagnosis and provides therapeutic benefit simultaneously.
This injection procedure targets the epidural space at the exact location where the affected nerve root exits the spine, delivering medication directly to the site of inflammation. The transforaminal approach specifically refers to entering the epidural space through the neural foramen, allowing for more precise delivery of medication to the affected nerve root compared to other epidural approaches.
Should a transforaminal epidural injection provide significant but temporary pain relief, repeated injections may be recommended, typically limited to three to four times yearly. For some patients, this may be followed by other interventions such as physical therapy, rehabilitation exercises, or consideration of surgical options if conservative treatments fail to provide adequate long-term relief.
THE DIAGNOSIS FOR USE OF TRANSFORAMINAL EPIDURAL STEROID INJECTIONS
Radicular pain commonly manifests as specific nerve-related symptoms radiating from the spine into the arms or legs, often accompanied by numbness, tingling, or weakness along the affected nerve's distribution. Compression or irritation of individual nerve roots can result from disc herniations, foraminal stenosis, or post-surgical scarring, and these conditions are often visible on imaging studies such as MRI scans.
To target inflammation around specific spinal nerve roots, we inject a combination of local anesthetic and anti-inflammatory medication (usually a corticosteroid) into the epidural space. We access this space through the neural foramen where the targeted nerve root exits the spine—this is why these injections are called transforaminal epidural injections.
Research indicates that transforaminal epidural injections can provide significant pain relief for patients with radicular pain due to nerve root compression or irritation. The precision of this approach allows for delivery of medication directly to the affected nerve root, potentially providing more targeted relief compared to other epidural approaches.
For persistent radicular pain, transforaminal epidural injections can be used as part of a comprehensive treatment plan that may include physical therapy, medication management, and in some cases, surgical consultation if conservative treatments fail to provide adequate relief.
INJECTION PROTOCOL
The primary purpose of the injection is to reduce inflammation around the specific nerve root and alleviate radiating pain. Consequently, implementing a consistent pain measurement method is essential. The Visual Analog Scale (VAS) is commonly used, rating pain from 0 to 10—where 0 represents no pain and 10 indicates extreme pain that completely inhibits thinking, movement, and normal functioning.
Patients should continue their regular medication schedule prior to the procedure, except for blood thinners which may need to be temporarily discontinued (only after consultation with your physician). For the procedure to be appropriately evaluated, patients should keep track of both their local spine pain and radiating pain levels before and after the injection, noting particularly how their radiating symptoms respond.
THE PROCEDURE
The injection requires inserting a needle through the skin under fluoroscopic (X-ray) guidance. The needle is carefully guided through the neural foramen—the opening where the targeted nerve root exits the spine. Contrast dye is always used to confirm proper placement and ensure no vascular uptake before the medication is injected.
It's perfectly normal to feel anxious about the procedure. However, you can be reassured that these injections are performed routinely, generally involve minimal discomfort due to local anesthetic use, and usually take less than 30 minutes to complete. Some patients may experience temporary reproduction of their typical pain pattern during needle placement or injection, which is actually helpful for confirming that the correct nerve root is being targeted. Temporary numbness or weakness in the distribution of the treated nerve may occur after the procedure, but these effects typically resolve within hours.