Lumbar Transforaminal Epidural Steroid Injections (TFESI)

What Is a Lumbar Transforaminal Epidural Steroid Injection?

A lumbar transforaminal epidural steroid injection (TFESI) is a targeted, image-guided procedure used to treat lower back pain that radiates into the leg, commonly referred to as sciatica or lumbar radiculopathy.

In the lumbar spine (low back), nerve roots exit the spinal canal through small openings called foramina. When these nerves become compressed or inflamed, often due to a herniated disc, spinal stenosis, or degenerative changes, patients may experience:

• Pain radiating into the buttock, thigh, calf, or foot

• Burning or electric-type pain

• Numbness or tingling

• Leg weakness

A lumbar TFESI delivers anti-inflammatory medication directly around the irritated nerve root to reduce inflammation and calm nerve irritation at its source.

How the Procedure Works

The procedure is performed in an outpatient setting using live X-ray guidance (fluoroscopy) to ensure precise needle placement.

During the injection:

1. You lie comfortably on an X-ray table.

2. The skin is cleaned and numbed.

3. A thin needle is guided into the neural foramen at the affected lumbar level.

4. Contrast dye confirms accurate placement.

5. A small amount of corticosteroid (anti-inflammatory medication), often combined with a local anesthetic, is injected around the nerve.

Because the medication is delivered directly to the affected nerve root, this approach allows for highly focused treatment compared to broader epidural techniques.

The procedure typically takes 15–30 minutes, and most patients go home the same day.

Conditions Treated

Lumbar TFESIs are commonly used to treat:

• Lumbar disc herniation

• Sciatica

• Foraminal stenosis

• Lumbar spinal stenosis

• Degenerative disc disease

• Nerve irritation following prior lumbar surgery

This procedure is particularly helpful when pain radiates down one leg in a specific nerve distribution.

What to Expect After the Injection

Some patients notice temporary immediate relief from the local anesthetic. The steroid medication typically begins working over several days and may continue improving symptoms over 1–2 weeks.

Pain relief can last weeks to months depending on the underlying condition. For many patients, the goal of the injection is to:

• Reduce inflammation

• Improve mobility

• Allow participation in physical therapy

• Decrease reliance on oral pain medications

• Avoid or delay surgery when appropriate

While some patients experience long-term relief, others may require repeat injections as part of a comprehensive treatment plan.

Risks and Safety

When performed by experienced specialists under image guidance, lumbar TFESIs are generally safe. However, potential risks include:

• Temporary increase in pain

• Headache

• Temporary numbness or weakness

• Elevated blood sugar (especially in patients with diabetes)

• Bleeding or infection (rare)

• Nerve irritation (rare)

Careful imaging guidance and sterile technique are essential to maximize safety and precision.

How Often Can Lumbar TFESIs Be Performed?

Steroid exposure is monitored carefully. Most patients receive a limited number of injections per year depending on response, medical history, and overall health considerations. Your treatment plan will be individualized based on your condition and goals.

Is This Right for You?

Lumbar transforaminal epidural steroid injections may be recommended when:

• Leg pain is more prominent than back pain

• Symptoms follow a clear nerve distribution

• Conservative treatments have not provided sufficient relief

• Imaging confirms nerve compression consistent with symptoms

These injections are often part of a broader strategy focused on restoring function, reducing inflammation, and helping you return to normal activity.

Reference

Educational content adapted from Cleveland Clinic and peer-reviewed interventional spine resources:
https://my.clevelandclinic.org/health/treatments/17572-transforaminal-injections