Understanding Lumbar Transforaminal Epidural Steroid Injection

What is it?

This outpatient procedure is an injection of a steroid-anesthetic medication. The medication can reduce swelling and inflammation of irritated spinal nerves. This procedure is performed to relieve pain in the lower back and pain that radiates from the back to the legs. The injection takes only a few minutes to complete.

How Does it Work?


In preparation for the procedure, the patient lies face down. A cushion is placed under the abdomen, which causes the spine to bend in a way that opens the spaces on the sides of the spine. These spaces are called the foramina.

Anesthetic Injected

A local anesthetic is administered to numb the skin and the tissue that covers the spine.

Needle Inserted

When the area is numb, the physician carefully guides a needle into the foraminal space that surrounds the irritated nerve root.

Contrast Solution Injected

A contrast solution is injected through the needle. The physician uses a fluoroscope (a type of x-ray device) to confirm that the tip of the needle is positioned correctly.

Medication Injected

After the needle’s position has been confirmed, the physician injects a steroid-anesthetic medication. This medication bathes the irritated nerve roots. It will help alleviate the patient’s pain.

End of Procedure

When the procedure is complete, the physician removes the needle and bandages the insertion site. The patient may feel significant relief after one injection. Some patients may need multiple injections before they feel the full benefit of the medication.


Lumbar transforaminal epidural steroid injections offer therapeutic benefits, especially for individuals dealing with conditions like spinal stenosis or disc-related lower back pain. By precisely delivering corticosteroid medication to the epidural space near the affected nerve root, these injections effectively reduce inflammation and provide targeted pain relief. This minimally invasive procedure not only helps manage pain but also allows patients to participate in physical therapy and regain mobility while minimizing the risk of complications associated with more invasive treatments.

Effective Pain Relief

Lumbar transforaminal epidural steroid injections provide highly effective pain relief by precisely targeting the source of discomfort. By delivering corticosteroid medication directly to the epidural space near the affected nerve root, these injections effectively reduce inflammation, providing rapid and targeted pain relief for individuals suffering from conditions like spinal stenosis and disc-related lower back pain.

Improved Mobility and Function

One of the key benefits of lumbar transforaminal epidural steroid injections is the improvement in mobility and function that they offer. By alleviating pain and reducing inflammation, these injections enable individuals to regain control over their movements and daily activities. Patients often experience enhanced flexibility and range of motion, making it easier to engage in physical therapy and regain their quality of life. Improved mobility and function are essential components of the overall goal of pain management and rehabilitation.

Risks and Complications

While lumbar transforaminal epidural steroid injections (TFESIs) can be effective in managing lumbar radicular pain, low back pain, and related conditions like lumbar radiculopathy, they are not without risks and potential complications. It’s crucial for patients to have a comprehensive understanding of these factors before undergoing the procedure.

  • Infection: Any invasive medical procedure carries a slight risk of infection, although stringent sterile techniques are employed to minimize this possibility.
  • Bleeding: While uncommon, some patients may experience minor bleeding or bruising at the injection site.
  • Nerve Damage: There is a minimal risk of nerve damage associated with needle placement, which can result in temporary or, rarely, long-term nerve-related symptoms.
  • Allergic Reactions: Although rare, allergic reactions to the injected medications, such as corticosteroids or local anesthetics, can occur.
  • Temporary Pain Flare-Up: In some cases, patients may encounter a temporary increase in pain immediately following the injection. Fortunately, this typically subsides within a few days.
  • Dural Puncture: Accidental puncture of the protective covering around the spinal cord (dura) is a rare but severe complication that can lead to headaches and other symptoms.
  • Systemic Effects: While TFESIs primarily target the local area, there is a possibility of systemic effects, particularly in patients receiving multiple injections over time.

Southern Pain and Spine is dedicated to providing specialized care for patients dealing with chronic pain conditions, including those benefiting from lumbar TFESIs. Our team of specialists, led by Dr. Ammar, uses their expertise in interventional pain management and regenerative medicine to assess and treat patients comprehensively.

By choosing Southern Pain and Spine, patients receive the support, expertise, and care needed to manage their chronic pain conditions effectively and improve their quality of life.

Possible Side Effects

Lumbar transforaminal epidural steroid injections (TFESIs) can be effective for pain relief, but like any medical procedure, they may entail certain side effects. It’s essential for patients to be aware of these potential effects as part of their decision-making process and to closely follow their healthcare provider’s guidance for a safe and successful procedure.

  • Pain at the Injection Site: It’s common for patients to experience mild discomfort or soreness at the site where the injection was administered. This typically subsides within a few days.
  • Temporary Numbness or Weakness: Some patients may encounter temporary numbness or weakness in the legs. This is often due to the local anesthetic used during the procedure and generally resolves quickly.
  • Post-Injection Pain Flare-Up: In some instances, patients may notice a temporary increase in pain following the injection. This discomfort is typically short-lived and should resolve within a few days.
  • Infection or Bleeding: While rare, there is a minimal risk of infection or bleeding at the injection site. Providers follow strict sterile techniques to minimize these risks.
  • Allergic Reactions: Although uncommon, allergic reactions to the injected medications (corticosteroids or local anesthetics) can occur. Patients with known allergies should inform their healthcare provider.
  • Dural Puncture: Accidental puncture of the dura (the protective covering around the spinal cord) is a rare but serious complication that can lead to headaches and other symptoms.
  • Systemic Effects: While TFESIs are primarily localized, there’s a minimal possibility of systemic effects, especially if multiple injections are administered over time.

Evidence and Studies of Transforaminal Injection

Research and clinical studies provide strong evidence that lumbar transforaminal epidural steroid injections (TFESIs) effectively reduce pain and improve functionality in patients with conditions such as lumbar radicular pain and disc herniation. These studies also emphasize the safety, long-term efficacy, and cost-effectiveness of TFESIs as part of pain management strategies.


In conclusion, it offer an effective and evidence-based approach for managing chronic pain conditions like lumbar radiculopathy and herniated discs. These injections can provide substantial pain relief, improve mobility, and enhance the overall quality of life for patients suffering from lumbar spine-related discomfort. While the procedure carries some risks and potential complications, the benefits, supported by numerous studies and evidence, make TFESIs a valuable tool in interventional pain management when administered by experienced specialists like us at Southern Pain and Spine.