Transforaminal Epidural Steroid Injection (TFESI)

A straightforward Guide for Patients

What is a Lumbar Transforaminal Epidural Steroid Injection?

A TFESI is a minimally invasive, therapeutic procedure performed to treat low back and leg pain caused by nerve irritation, such as sciatica or chronic radicular pain. It is performed in a sterile suite using fluoroscopy (X-ray guidance) for precision. A combination of a corticosteroid (steroid) and a local anesthetic is injected near the affected nerve. The patient lies face down or on their side; local anesthesia is applied to the skin before the injection

Purpose of the Injection

  • It is intended to reduce inflammation and provide lasting pain relief for irritated spinal nerves. Relief can last for weeks or months, depending on the individual patient’s response.

What to Expect During the Procedure

The injection is performed in a sterile procedure room using real-time X-ray guidance for accuracy and safety.

  • The skin is cleaned and numbed with a local anesthetic.
  • Most patients do not need sedation, although it may be offered for certain approaches.
  • Occasionally, you may feel a brief “electric” sensation down the leg or arm depending on the area treated—this is normal and not harmful.
  • The procedure typically takes about 10-15 minutes.

Aftercare Instructions

General Care

  • If you received sedation, do not drive or operate machinery for 24 hours.
  • You may return to normal daily activities as tolerated.
  • Showering is allowed, but avoid soaking in a tub, pool, or lake for 24 hours.
  • Pain relief may take 7–10 days as the steroid begins working.
  • The care team will call you the next day to check on your recovery.

If Sedation Was Used

  • No solid food for 8 hours before the procedure.
  • Clear liquids only up to 2 hours before your appointment
    (water, broth, clear juice without pulp, black coffee or tea).
  • No carbonated drinks, gum, candy, mints, or throat lozenges in the 2 hours prior.
  • The care team will review your medications and tell you which ones to take beforehand.
  • Not following these instructions may require the procedure to be rescheduled.

Possible Risks and Side Effects

While generally safe, potential risks include:

  • Temporary soreness or a temporary increase in pain at the injection site.
  • Infection or bleeding (especially for those on blood thinners).
  • Dural puncture (which may cause a “spinal headache”).
  • Rare nerve or spinal cord injury.

When Will I Feel Relief?

  • Immediate: Any initial relief is usually due to the local anesthetic and is temporary.
  • Long-term: The steroid begins working gradually; most patients notice a therapeutic improvement within 7–10 days.

Insurance Requirements

Most insurance plans require specific documentation before approving a TFESI:

  • Failed Conservative Care: Evidence of at least 4 to 6 weeks of conservative treatment, such as physical therapy or home exercise programs.
  • Imaging: Recent imaging (MRI or CT) confirming nerve root involvement or structural causes for the pain.
  • Frequency Limits: Most plans limit these to a maximum of 4 sessions per region in a rolling 12-month period.