Picture Courtesy of spinesurgeon.co.uk

Transforaminal Epidural Steroid Injections/Selective Nerve Blocks (TFESI/SNB): These two types of injections are very similar.  For the sake of simplicity, Dr. Lee will concentrate on TFESI.  You can assume that SNB have the same purpose and the procedure is done very similar to TFESI.  TFESIs are a variation of the regular Epidural Steroid Injections, but are more specific to treatment of affected nerve roots causing your pain.

Common Indications for TFESIs: There are many indications for Transforaminal Epidural Steroid Injections.  Some of the more common ones include cervical radiculopathy (arm/hand pain spreading from the neck) and lumbar radiculopathy (leg/foot pain spreading from the low back).   They also work well for thoracic radiculopathy (e.g. chest wall or rib pain spreading from your mid back).  TFESIs are indicated for disc degeneration, spinal stenosis, herniated discs, and radiculopathy/sciatica.  The injections deposit medication directly to the source of the diseased nerve root (e.g. origin of the nerve at the spinal cord), thus allowing for direct relief of the nerve inflammation causing your pain.

Technique:  At SCCPM, transforminal epidural steroid injections are performed at the surgery center under live x-ray (fluoroscopy) for safety and accuracy.  We will also give you moderate IV sedation (i.e. “twilight sleep”) as an option for your comfort, although many patients have had the procedure performed with local anesthetic alone without discomfort.  You will be checked in at the surgery center and brought into the operating suite, where you will be greeted by the doctor and registered nurse.  After placing monitors (e.g. blood pressure cuff, EKG, etc) on you, the nurse will give you IV sedation (if ordered).  Afterwards, the doctor will begin by “numbing” the injection site with a local anesthetic.  Afterward, with the aid oof the fluoroscope, Dr. Lee will perform the actual TFESI, in which a long acting steroid solution and local anesthetic will be injected adjacent to the diseased spinal nerve(s), where the inflammation causing your pain is located.  After appropriate monitoring, you will then be transferred to the recovery unit before going home with a family member or friend.  You are encouraged to “take it easy” for the rest of the day, and to follow the post-procedure instructions ordered by Dr. Lee.  You will be able to resume your normal activities the next day.

Pain Relief Response and Duration: Most patients can expect pain relief to set in 1-2 days after the first injection.  There will be some who will get immediate relief, while others may take 1-3 weeks for the relief to set in.  There will be a small % of patients who may not respond to the injection at all.  Unfortunately, the doctor cannot always predict your individual response beforehand.  Likewise, the duration of pain relief is variable.  Most patients can expect relief for months, and some have reported relief for even years.  There will be a minority who responds short-term, with relief for only days to weeks, or not at all.  Again, each patient’s response is different, just as each patient’s pain condition is unique.

Injection Series: Most patients get relief with just one injection, although a minority of patients will require more to get relief.  There is no set rule on the number of injections required.  In general, most pain doctors (including Dr. Lee) may perform up to a “series of 3″ TFESIs.  A  “series of 3″ injections may be performed to ensure pain relief as well as prolong the duration of pain relief (as mentioned above).  There are no set guidelines to the number of ESIs a patient can get in a year or “life time”.  But, in general, patients may need to repeat the ESI or ESI injection series when the pain returns over time (e.g. weeks to month to years).  As each patient’s pain condition is unique, it is best to discuss with the doctor about your pain condition and the best course of treatment.