Lumbar Transforaminal Epidural Steroid Injection

Lumbar Transforaminal Epidural Steroid Injection

(Fluoroscopic-Guided Targeted Injection for Nerve Root Pain Relief)

Overview

A lumbar transforaminal epidural steroid injection (TFESI) is a minimally invasive procedure used to treat lower back and leg pain resulting from irritation or compression of spinal nerve roots. Unlike traditional epidural injections, TFESI delivers medication more precisely to the affected nerve as it exits the spinal column, offering targeted relief.

This procedure is often used when symptoms are caused by herniated discs, foraminal stenosis, or nerve root inflammation.

Conditions commonly treated with TFESI include:

  • Lumbar radiculopathy (sciatica)
  • Foraminal disc herniation
  • Foraminal stenosis
  • Nerve root inflammation from workplace or auto injury
Lumbar Epidural Steroid Injection

What are the risks and side effects?

Risks and side effects are minimal, and serious complications are rare. We take every precaution to ensure your safety. Potential risks may include but are not limited to:

  • Vasovagal response (fainting or dizziness)
  • New or increased pain
  • Infection
  • Bleeding
  • Permanent skin changes
  • Allergic or unexpected drug reaction with minor or major consequences
  • Unintended spinal or nerve injury

Ask your provider if you have any concerns. Your physician will review the risks in detail before the procedure to ensure you are fully informed.

Pre-Procedure Information

How Should I Prepare?

  • Driver Required: We ask that you arrange for a driver to take you home after the procedure.
  • Food: You may eat a light meal 1–2 hours prior to the procedure. If sedation is planned, please follow the specific sedation protocol provided by our team.

Medications

  • Continue routine medications unless instructed otherwise.
  • Blood thinners, NSAIDs, aspirin, and supplements:
    • Inform us in advance if you take blood thinners (e.g., Plavix, Eliquis, Xarelto, Coumadin), NSAIDs (e.g., ibuprofen, naproxen), Aspirin, or supplements that increase bleeding risk.
    • Certain medications may need to be stopped for a short period of time before the injection.
    • Speak with your prescribing provider to ensure it’s safe to temporarily stop these medications.
    • Our team will review your medication list and coordinate with your other providers if needed.

    Notify us if:

    • You have a fever, infection, or recent illness.
    • You have started antibiotics or had changes to your medications.

Sedation

Most procedures can be performed comfortably without sedation. However, if you have anxiety or difficulty lying flat, mild sedation may be offered at the discretion of the physician. Please discuss this with your provider in advance.

Special Instructions for Diabetic Patients:

Steroid injections may raise blood sugar levels for several days.

  • Please contact your primary care physician or endocrinologist prior to the procedure for management recommendations.
  • Monitor your glucose closely after the injection.
  • Report sustained elevations to your managing provider.

What if I am pregnant?

There are serious potential risks to an unborn fetus from imaging used during this procedure (e.g., X-ray/fluoroscopy). If there is any chance you may be pregnant, please notify our team immediately and postpone the injection until pregnancy is ruled out.

Procedure Details

The procedure is performed using sterile technique under real-time X-ray (fluoroscopic) guidance.

What to Expect:

Preparation:

  • You will lie face down on a fluoroscopy table.
  • The skin is cleaned, and local anesthesia is used to numb the area.

Injection Process:

  • A needle is guided into the foramen (the nerve passageway in the spine).
  • Contrast dye is used to confirm placement.
  • A corticosteroid is delivered directly next to the inflamed nerve root.

Monitoring:

  • You will be monitored throughout the procedure and observed afterward before discharge.
  • Most procedures last 15–30 minutes, followed by a brief recovery period on-site.

Post-Procedural Instructions

What to Expect After the Procedure

  • Pain Relief Timeline: Steroids typically begin to work within 2 to 5 days, but in some cases may take up to 2 weeks.
  • Activity: You may resume light activities the next day; avoid strenuous activity for 24 hours. We recommend you return to work the following day.
  • Soreness: Temporary soreness at the injection site is common.
  • Pain tracking: Keep a log of symptoms over the next 1–2 weeks.

If successful, additional injections may be spaced out over time—typically no more than 3–4 per year in the same region.

Additional Instructions:

  • Contact the office for any signs of infection, fever, worsening pain or new weakness or sensory changes.
  • Attend follow-up as scheduled.

Schedule a Consultation

If you're experiencing nerve-related lower back or leg pain that hasn’t improved with conservative care, a lumbar transforaminal epidural steroid injection may help. Contact Restore Spine and Pain today to schedule a consultation and learn about your treatment options.

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