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.
Epidural glucocorticoid injections are commonly given to patients with leg and/or back pain to relieve this pain and improve mobility without surgery. These steroid injections buy time to allow healing to occur and/or as an attempt to avoid surgery after other conservative (non-surgical) treatment approaches have failed (physical therapy, exercise, chiropractic therapy).
During a transforaminal injection, a small-gauge blunt needle is inserted into the epidural space through the bony opening of the exiting nerve roots. The needle used during this procedure is smaller in size than that used during a conventional epidural approach. The procedure is performed with the patient lying on their stomach using fluoroscopic (real-time x-ray) guidance, which helps to prevent damage to the nerve root. This technique allows the glucocorticoid medicine to be placed closer to the irritated nerve root than using conventional interlaminar epidural approach. The exposure to radiation is minimal.
Indications include large disc herniations, foraminal stenosis, and lateral disc herniations. Patients with disc herniations and leg pain in most of the studies attained maximal improvement in 6 weeks.
Some patients report pain relief within 30 minutes after the injection, but pain may return a few hours later as the anesthetic wears off. Longer term relief usually begins in two to three days, once the steroid begins to work.
How long the pain relief lasts is different for each patient. For some, the relief lasts several months or longer. If the treatment works for you, you can have periodic injections to stay pain-free.
Interestingly, long-term success rates for transforaminal epidural glucocorticoid injections ranged from 71% to 84%.
As a rule, patients who obtained little relief from the first injection got little benefit from a second or third injection. Those patients with degenerative lumbar canal stenosis and patients who failed previous therapies may significantly improve standing and walking tolerance following transforaminal lumbar steroid injections. However, only about 15% to 61% of interventional pain management physicians perform transforaminal epidural injections. Interestingly, almost every single interventional pain management physician uses the conventional, interlaminar epidural injection.
Transforaminal injection may be right for you if your back or leg pain has lasted longer than four weeks, is severe or has not improved with other treatments, such as physical therapy.
Talk to one of our providers about it by scheduling an evaluation by calling 770-771-6580. We look forward to helping you regain life, restore function and renew hope!
1. Botwin T, Rittenberg B. Am J Phys Med Rehabil 2002; 81:898-895.
2. Vad VB, Bhat AL, Lutz GE, et al. Spine 2002; 27:11-16.
3. Lutz GE, Vad VB, Wisneski RJ. Arch Phys Med Rehabil 1998; 79:1362-1366.