Transforaminal Epidural Steroid Injection (TF ESI)

A Transforaminal Epidural Steroid Injection (TFESI) is a targeted injection of steroid medication and local anesthetic into the epidural space of the spine via the foramen — the small opening through which spinal nerves exit. This injection helps reduce inflammation and nerve irritation, providing pain relief.

• Herniated or bulging discs
• Sciatica or radicular pain (radiating leg/arm pain)
• Spinal stenosis
• Degenerative disc disease
• Nerve root inflammation

• Reduce inflammation around the nerve
• Relieve pain, numbness, or tingling
• Improve mobility and function
• Help postpone or avoid surgery
• Assist with diagnosis (by identifying the source of pain)

• Fasting: You may be asked to avoid eating or drinking for 6–8 hours beforehand.
• Medications: Review all medications with your provider. You may need to stop blood thinners.
• Transportation: Arrange for someone to drive you home. You should not drive yourself after the procedure.

• You will lie face down on a procedure table.
• The skin is cleaned, and local anesthetic is used to numb the area.
• Using fluoroscopy (live X-ray), a needle is guided into the foramen near the affected nerve root.
• A contrast dye may be used to confirm correct needle placement.
• A combination of steroid and anesthetic is then injected.
• The procedure usually takes 15–30 minutes.

What to Expect:

• You may feel immediate relief from the anesthetic, but this is temporary.
• Steroid medication typically begins to work within 2–5 days, with maximum benefit in 1–2 weeks.
• Mild soreness or pressure at the injection site is common.

Activity:

• Rest for the remainder of the day.
• Avoid strenuous activity or heavy lifting for 24–48 hours.
• Gradually return to your normal activities.

While generally safe, potential risks include:

• Temporary increase in pain
• Headache
• Bleeding or bruising
• Infection
• Nerve injury (rare)
• Allergic reaction to contrast or medication

Let your provider know if you have a contrast allergy or history of complications with steroid injections.

• Fever, chills, or redness/swelling at the injection site
• Severe or worsening pain
• New numbness, weakness, or difficulty walking
• Loss of bladder or bowel control (emergency)

TFESIs can be repeated, but typically no more than 3–4 times per year, depending on your response and your provider's guidance.