What is a Transforaminal Epidural Steroid Injection (TFESI)?

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A TFESI is an injection used for both therapeutic and diagnostic purposes. A needle is placed in the area from which nerves exit the spine. It is especially helpful for patients with leg pain from multi-level disc disease, disc herniation, spondylolisthesis, spinal stenosis or patients who have had failed spinal surgeries.

TFESI, sometimes called a selective nerve root block, is performed in the office where x-ray equipment is used to verify needle placement.

Patients are placed in the prone (face down) position. The provider will wash the skin with a sterile prep. Local anesthetic is used in the skin. The needle is placed using x-ray guidance in the bony hole on the side of the spine (the foramen) through which the nerve root of that level exits the spine to supply muscles and sensory organs. For those who do not have an allergy to contrast dye, this is then injected through the needle to verify needle placement. Once placement is checked, steroid medication and local anesthetic is then injected via the needle. TFESIs can be repeated at specific intervals if relief is obtained.

Side effects can include sympathetic blockade, infection, cerebral spinal fluid leak, nerve root laceration, hematoma and spinal stroke. These complications are exceedingly rare. The use of x-ray guidance decreases the possibility of such complications.

Patients usually have diminished pain immediately after the procedure. The local anesthetic wears off after several hours. It may take several days for steroid medication to work. The nerve root might react to the irritation of the procedure, causing a few days of increased pain. This should subside in a few days.

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