.png)
Transforaminal Epidural Steroid Injection
A transforaminal epidural steroid injection (TFESI) is one of the most targeted and effective approaches for delivering anti-inflammatory medication directly to an irritated spinal nerve root.
What is a Transforaminal Epidural Steroid Injection?
A transforaminal epidural steroid injection (TFESI) is one of the most targeted and effective approaches for delivering anti-inflammatory medication directly to an irritated spinal nerve root. Unlike a standard (interlaminar) epidural injection, which introduces medication into the general epidural space from the midline of the spine, a transforaminal injection approaches from the side — directing medication through the neural foramen, the opening where each nerve exits the spine. This approach allows the medication to reach the anterior (front) epidural space more effectively, bathing the affected nerve root in corticosteroid right at the site of inflammation. At River Cities Interventional Pain Specialists, TFESIs are performed under fluoroscopic guidance for precise, level-specific treatment.
What To Expect
The procedure is performed in our clinic or at Park Plaza Surgical Specialists and typically takes 20–30 minutes:
✔️ You'll be positioned on your side or face-down depending on the target level, and the skin will be cleaned and numbed.
✔️ Using fluoroscopic imaging, Dr. Brewer advances a thin needle through the neural foramen to the specific nerve root being treated.
✔️ Contrast dye is injected to confirm that medication will flow to the anterior epidural space and coat the nerve root.
✔️ Corticosteroid with anesthetic is then carefully injected at the target level.
✔️ You'll be monitored for 20–30 minutes before returning home.
Results and Recovery
Recovery is very similar to a standard epidural injection. Mild soreness at the injection site may be present for 24–48 hours. Many patients notice improvement in their radiating arm or leg pain within 3–7 days as the steroid reduces nerve root inflammation. Results typically last weeks to several months. We'll schedule a follow-up to assess your response and discuss whether additional treatment is needed.
WHO IS THIS BEST FOR?
A transforaminal ESI is particularly effective for patients with:
✔️ Single-level herniated disc causing radiating arm or leg pain
✔️ Foraminal stenosis (narrowing at the nerve exit point) causing radiculopathy
✔️ Post-surgical epidural fibrosis (scar tissue) that blocks standard midline access
✔️ Sciatica that hasn't responded to standard epidural approaches
✔️ Cervical radiculopathy causing neck pain with arm numbness, tingling, or weakness
✔️ Cases where a specific nerve root has been identified as the pain source and needs targeted treatment
Frequently Asked Questions
The transforaminal approach is more targeted than a standard interlaminar ESI. Because it accesses the anterior epidural space — where most disc herniations and nerve root irritation occur — it often provides superior relief for specific nerve root pathology. Dr. Brewer will recommend the best approach based on your imaging and clinical picture.
Not significantly. Both procedures use local anesthetic to numb the skin and approach, and most patients experience only mild pressure or brief discomfort. The transforaminal approach is actually often described as very well-tolerated.
Yes, cervical transforaminal ESIs are performed for arm pain from cervical nerve root compression. The technique requires additional precautions given the proximity of blood vessels in the cervical spine, and Dr. Brewer will discuss these with you before the procedure.
Many patients experience significant relief from one or two injections. We typically recommend a maximum of 3 injections in a 12-month period to limit cumulative steroid exposure. If multiple rounds of injections are not providing lasting relief, we'll discuss additional treatment options.
.png)
Leaders In Shreveport Pain Management for Over 20 Years