If you’re living with low back pain, sciatica, or nerve inflammation, your physician may recommend a Transforaminal Lumbar Epidural Steroid Injection (TFESI). This minimally invasive procedure can help reduce pain and improve mobility when other treatments have not provided enough relief.
What Is the Epidural Space?
The epidural space surrounds the dura, a protective covering of the spinal cord and nerves. In the lower back, it is called the lumbar epidural space. This area is important because it’s where nerve roots travel before branching out to the legs.
What Causes Pain in the Lumbar Spine?
The lumbar spine has five bones, called vertebrae, with soft discs between them. These discs cushion the bones, support movement, and hold the spine together. Pain in this area often comes from problems such as:
- Disc tears – If a disc tears, chemicals inside can leak out, irritating nerve roots or the dura.
- Disc bulges or herniations – A larger tear can cause the disc to bulge, pressing on nerves and creating pain.
- Bone spurs (osteophytes) – Over time, arthritis or spinal degeneration may lead to bony growths that pinch or compress nerve roots.
What Is a Transforaminal Lumbar Epidural Steroid Injection (TFESI)?
A TFESI injection delivers a small dose of corticosteroid (an anti-inflammatory medication) into the epidural space. The injection is made from the side of the spine where nerves exit—called the transforaminal approach—so the medication is placed directly at the source of inflammation.
This targeted treatment may reduce swelling around irritated nerves, relieve pain, and improve function.
What Happens During a TFESI Procedure?
- Your skin is numbed with local anesthetic.
- A thin needle is carefully inserted into the epidural space under fluoroscopic (live X-ray) guidance.
- Contrast dye may be used to confirm proper needle placement.
- Corticosteroid medication is then slowly injected.
During the injection, you may feel pressure or mild discomfort, which usually resolves quickly once the procedure is complete.
How to Prepare for Your Injection
- Do not take pain medication the morning of your procedure (unless otherwise directed).
- Continue your other daily medications unless instructed differently.
- Wear loose, comfortable clothing.
- Plan to spend about an hour at the office or ambulatory surgery center (ASC).
- Bring a driver to take you home after your injection.
What to Expect on Procedure Day
- You will lie face-down on an X-ray table, sometimes with pillows for support.
- Your back will be cleaned with antiseptic, and a sterile drape will be placed.
- The needle will be guided with fluoroscopy to ensure safety and accuracy.
- Contrast dye may be injected before the steroid to confirm proper spread.
- After the injection, the needle is removed and a small dressing is applied.
Recovery and Aftercare
- Your vital signs will be monitored for 15–20 minutes.
- Once stable, you can go home the same day.
- You will not be able to drive immediately after the procedure, so please have a driver available. Most patients can resume driving within 3–4 hours.
How Long Until Pain Relief Begins?
- Some patients feel immediate improvement.
- Most patients notice relief within 24–72 hours.
- Full benefit may take up to two weeks.
- More than one injection may be needed for lasting relief.
Key Benefits of TFESI Injections
- Minimally invasive
- Outpatient procedure (performed in-office or at an ASC)
- Helps reduce inflammation at the nerve root
- Can relieve pain in the lower back, buttocks, and legs
- May improve mobility and quality of life
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.
