Transforaminal epidural steroid injection (TESI)

Overview

A transforaminal epidural steroid injection (TESI) is a specialized procedure designed to reduce spinal pain and inflammation, especially pain that radiates from the spine to areas like the arms, legs, and feet. This technique can provide relief by addressing both local pain and referred pain caused by irritated nerves in the spine.

The term “transforaminal” refers to the path the needle takes, specifically through the foramina, which are openings where nerves exit the spinal canal and extend to other body areas. The injection is also called “epidural” because it targets the epidural space, which is located around the dura mater—a protective membrane surrounding the spinal cord. During the procedure, the steroid medication is carefully injected into this space around the nerves, rather than directly into the nerves or spinal cord itself, ensuring safety and precision.

To further enhance accuracy, the transforaminal approach requires X-ray guidance, known as fluoroscopy. This imaging technique allows providers to view real-time X-ray images, helping them pinpoint the exact location of the affected spinal nerves. The added precision from fluoroscopy ensures the injection is correctly placed for maximum effectiveness in reducing pain and inflammation.

Reasons for undergoing the procedure

Transforaminal epidural steroid injections are used by doctors to treat:

• Scoliosis
• Sciatica
• Bone spurs
• Spondylolysis
• Spondylolisthesis
• Herniated disk
• Spinal stenosis
• Lower back pain
• Foraminal stenosis
• Spinal nerve damage
• Compression of the spine (resulting in a pinched nerve)

Types of transforaminal epidural steroid injections

Doctors may use different terms when discussing these injections, such as lumbar, cervical, or thoracic transforaminal epidural steroid injections. These names indicate the specific area of the spine being treated. For example:

• Lumbar transforaminal epidural steroid injections target nerves in the lower back. When these nerves become inflamed, they can cause pain in the lower back or radiate down to the legs.
• Thoracic transforaminal epidural steroid injections focus on nerves in the middle part of the back. Inflammation in these nerves may lead to pain in the mid-back area or pain radiating to the chest or abdomen.
• Cervical transforaminal epidural steroid injections address nerves in the neck and upper spine. When these nerves are inflamed, they can result in neck pain or pain that radiates to the shoulders, arms, or hands.

Risks

This type of injection carries a very low risk of complications. However, in rare instances, issues such as injection-site bleeding, infections, or nerve damage may occur. Potential side effects of a transforaminal epidural steroid injection include:

• Dizziness
• Headache
• Weakness or numbness in the feet or legs

Generally, these side effects are temporary and typically resolve within a few hours.

During the procedure

You will lie on your stomach on an X-ray table during the procedure. Before starting, your doctor will numb your skin with a local anesthetic injection, which may cause a slight pinching or burning sensation. To enhance your comfort, your doctor might also offer intravenous sedation. While this sedation can make you feel drowsy, you will remain awake and able to communicate with your doctor. (Be sure to discuss your sedation options during your initial consultation.)

Once you are comfortable, your doctor will begin the procedure using fluoroscopy to:

1. Insert a long, thin needle into your back to target the specific nerve root responsible for your pain.
2. Inject a combination of steroid medication (for longer-lasting relief) and anesthetic (for immediate pain relief).

The entire process usually takes about thirty minutes.

After the procedure

You can resume your regular medications and diet immediately after the procedure. However, it’s important to take it easy, avoid strenuous activities, and refrain from driving for twelve hours. The following day, you can return to your normal routine.

The steroid may take up to two weeks to reach its maximum effect, and you might start feeling relief within 24 to 48 hours. If you don’t notice any improvement after 14 days, be sure to consult your doctor to discuss alternative treatment options.

Outcome

After receiving a transforaminal epidural steroid injection, you may experience pain relief that lasts for several weeks or even months. The duration of relief varies from person to person. If the treatment proves effective, you may be able to receive injections regularly to help manage your symptoms. Generally, three to six transforaminal epidural steroid injections per year are considered safe; however, some individuals may require more while others may need fewer.

It’s important to note that the likelihood of side effects increases with the number of injections received. If you don’t experience any improvement after two or three injections, it’s unlikely that additional shots will be beneficial. Your doctor is the best person to advise you on how often you can safely receive this treatment and whether you should consider alternative options.