TFESI is an acronym for Transforaminal Epidural Steroid Injection. This is a procedure traditionally completed by a pain management specialist and occasionally by spine surgeons. There are several indications to perform this procedure, they mainly include pain for disc bulges and/herniations with narrowing around the spinal cord or the nerve branches off the of the spinal cord (these nerves exit out a gap between the bones of the spinal column called the neural foramen).
Pain from the narrowing around the nerves is often described as burning, sharp, stabbing, tingling, shocking, numb, and sometimes an ache. The pain can be worse when performing certain activities and while you are in certain positions. The reasons that pain started in the first place are varied and include something as small as bending over to tie a shoe, lifting heavy objects, and trauma like car accidents can be the cause as well.
The diagnosis for this comes in several stages. The clinical will perform a physical exam to test for nerve impingement and see if they can replicate the pain. An MRI is also usually ordered at the affected area (neck, midback, low back) to see where the problem is occurring. Sciatica is a common term for nerve pain running down the leg. If there are positive findings with the physical examination as well as narrowing around the spinal canal or neural foramen, a TFESI could help reduce your pain and increase function. This is often ordered before surgery is considered to have the lesser of the invasive options done first. TFESI can be done throughout the spine but traditionally isn’t used in the neck, where a different type of epidural, called an intralaminar epidural, is used (for safety reasons).
The procedure is rather simple. The patient will be on an OR table face down. The mid or low back is sterilized with a cleaning solution and then a drape is applied. Images with a fluoroscopic unit are taken of the thoracic or lumbar spine (the area identified on MRI). Once the correct level is identified, the physician will numb the area with Lidocaine at the skin then insert a spinal needle through the numbed skin. This needle will advance toward to neural foramen. Once the needle is close to the final location, a contrast dye will be injected to see if it spreads into the epidural space, it also makes it known if we are inside of a blood vessel. Once the proper location of the needle is confirmed, a solution of saline, a local anesthetic, and a steroid is injected. The needles are then removed and a band-aid applied. The procedure only takes a few minutes to complete and there is typically a relief of pain quickly if a local anesthetic is used in the injectate.
Side effects are minimal and unlikely but do include bleeding, infection, and nerve damage. These complications are reduced by using that sterilizing solution and also using the fluoroscopy machine so that we see the spinal column and the needle with each move.