Name of the Procedure:

Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level.

• Common Name: Transforaminal Epidural Steroid Injection (TFESI)
• Medical Terms: Lumbar/Sacral Transforaminal Epidural Injection

Summary

A transforaminal epidural steroid injection is a minimally invasive procedure designed to deliver medication directly into the epidural space of the spine to alleviate pain. This is done using imaging techniques like fluoroscopy or CT to guide the needle to the precise location.

Purpose

This procedure is performed to relieve pain and inflammation associated with conditions such as herniated discs, spinal stenosis, and sciatica. The goal is to provide pain relief, improve mobility, and reduce inflammation.

Indications

• Persistent lower back pain or sciatica
• Herniated or bulging discs
• Spinal stenosis
• Radiculopathy (nerve pain radiating from the spine)
• Failure to respond to conservative treatments like physical therapy

Preparation

• Fasting for several hours before the procedure if sedation is being used.
• Adjustments to regular medications (e.g., blood thinners may need to be paused).
• Pre-procedure diagnostic tests such as an MRI or CT scan to pinpoint the problem area.

Procedure Description

1. The patient lies face down on an X-ray table.
2. The skin over the injection site is cleaned and sterilized.
3. Local anesthesia is administered to numb the area.
4. Using fluoroscopy or CT imaging, the physician guides a needle into the transforaminal space.
5. Contrast dye is injected to ensure correct placement.
6. An anesthetic agent and/or steroid medication is injected into the epidural space.
7. The needle is removed, and the injection site is covered with a sterile dressing.

Duration

The procedure typically takes about 30-45 minutes, including preparation time.

Setting

The procedure is usually performed in an outpatient clinic, hospital, or specialized surgical center.

Personnel

• Interventional pain specialist or anesthesiologist
• Radiologic technologist
• Nursing staff

Risks and Complications

• Common risks: Temporary pain at injection site, headache.
• Rare risks: Infection, bleeding, nerve damage, severe allergic reaction.
• Complications are managed with additional medications, rest, or further medical intervention.

Benefits

• Pain relief which may begin within a few days
• Reduced inflammation
• Improved range of motion and functional abilities
• Decreased need for oral pain medication

Recovery

• Post-procedure observation for a short period.
• Instructions to rest for the remainder of the day.
• Avoid strenuous activities for at least 24-48 hours.
• Follow-up appointments to assess effectiveness and plan further treatment if necessary.

Alternatives

• Physical therapy
• Oral medications (e.g., anti-inflammatories, pain relievers)
• Radiofrequency ablation
• Surgery for more severe cases
• Each alternative has its own pros and cons concerning efficacy, recovery time, and potential risks.

Patient Experience

• During the procedure, patients might feel some pressure or mild discomfort.
• Post-procedure, there may be temporary soreness at the injection site.
• Pain relief can vary, with some patients experiencing it almost immediately while others may take several days.
• Pain management options, including over-the-counter pain relievers, may be provided to enhance comfort post-procedure.