Transforaminal Cervical Epidural Steroid Injections (TFESI): What to Expect

If you’re struggling with neck pain, arm pain, or nerve-related discomfort caused by a cervical spine issue, a transforaminal cervical epidural steroid injection (TFESI) may help reduce inflammation and relieve your symptoms. This minimally invasive procedure targets irritated nerves in the neck to provide long-lasting pain relief.

What Is the Epidural Space?

The epidural space surrounds the protective covering of the spinal cord and its nerves, called the dura. In the neck, this area is known as the cervical epidural space. It’s a common site where inflammation or pressure on nerves can cause pain that radiates into the shoulders or arms.

What Causes Pain in the Cervical Epidural Space?

The cervical spine contains seven vertebrae (neck bones) with soft discs between them that act as cushions and help with movement. Pain can occur when these discs or nearby structures become damaged or inflamed. Common causes include:

• Disc tears: When a disc tears, chemicals inside may leak and irritate nearby nerve roots or the dura, causing pain.
• Disc bulges or herniations: A large tear can cause a bulge that presses on the nerves.
• Bone spurs (osteophytes): Over time, bone spurs can develop and compress nerve roots.
• These conditions can result in neck pain, arm pain, tingling, or numbness.

What Is a Transforaminal Cervical Epidural Steroid Injection (TFESI)?

A transforaminal cervical epidural steroid injection delivers a corticosteroid (a powerful anti-inflammatory medication) directly into the epidural space near the affected nerve root.

The word “transforaminal” refers to the path of the needle — it enters through the small opening (foramen) where the nerve exits the spine. This precise approach places medication close to the source of inflammation, improving accuracy and effectiveness.

What Happens During the TFESI Procedure?

1. Local anesthesia: The skin is numbed with a local anesthetic.
2. Needle placement: Using fluoroscopy (live X-ray guidance), the doctor carefully inserts a thin needle into the epidural space.
3. Contrast dye: A small amount of contrast dye confirms correct needle placement and medication spread.
4. Steroid injection: The corticosteroid medication is slowly injected to reduce inflammation around the nerve.

Patients may feel temporary pressure, tingling, or warmth in the neck or arm during the injection.

How to Prepare for a Cervical TFESI

Your transforaminal epidural injection is typically performed in an office-based surgical suite or ambulatory surgery center. To prepare:

• Hold any pain medications the morning of the procedure unless instructed otherwise.
• Take all other daily medications as usual (unless told not to).
• Wear loose, comfortable clothing.
• Plan to spend about 1 hour total at the facility.
• Arrange for a driver to take you to and from your appointment — you cannot drive yourself home afterward.

If you have questions about medications or preparation, contact our office at 843-730-4124.

What to Expect During the Procedure

You’ll lie on your side on an X-ray table, and the skin around your neck will be cleaned and covered with a sterile drape. Live fluoroscopy helps your provider accurately guide the needle into the epidural space.

You may feel a sensation of pressure or mild discomfort as the medication is injected. If the pressure becomes painful, let your provider know right away.

Once complete, the needle is removed and a small dressing is placed on the injection site.

After the Procedure: Recovery and Results

After the injection, your vital signs will be monitored for 15–20 minutes. Once stable, you’ll be discharged home.

When will I feel pain relief?

Some patients notice improvement immediately, but most experience relief within 24–72 hours, with full benefit taking up to one week. Depending on your condition, multiple injections may be recommended for optimal pain control.

Can I drive after the injection?

No — because numbing medication is used, you must have someone drive you home. You may safely resume driving 3–4 hours after the injection once you feel comfortable and alert.

Key Benefits of a Transforaminal Cervical Epidural Steroid Injection

• Targets inflammation directly at the affected nerve
• Minimally invasive and image-guided for safety
• Can reduce the need for oral medications or surgery
• May provide lasting relief from neck and arm pain

Learn More or Schedule an Appointment

If you’re suffering from cervical radiculopathy, herniated disc, or nerve pain, a cervical transforaminal epidural steroid injection could be a safe and effective treatment option.

To learn more or schedule an appointment, contact Signe Spine & Rehab in Mount Pleasant, SC at 843-730-4124 or visit our website to request a consultation.

Author

Nicohl Cave, CPC Practice Administrator and Certified Professional Coder. Nicohl has worked with the Signe Spine & Rehab for 8 years and is the expert about all things Signe Spine & Rehab. She has 10 years experience working in healthcare management in various healthcare settings.