Spinal nerve irritation can lead to all sorts of symptoms. Chief among them is pain. In some cases, the pain can radiate down the arms, torso, and legs. Conservative treatments include pain medication, physical therapy, and surgery. When those treatments fail or are deemed inappropriate, there is an alternative known as transforaminal epidural steroid injection (TFESI).
Lone Star Pain Medicine in Weatherford, Texas, often recommends TFESI for spinal stenosis and herniated discs. There are certainly more applications. In fact, there are three different types of TFESI procedures. Each is designed to relieve a certain type of pain.
The Basics of TFESI
Lone Star doctors describe TFESI as an outpatient, image-guided procedure. As an injection therapy, it delivers a combination of corticosteroids and a local anesthetic directly into the opening where the affected nerve roots branch off from the spinal cord.
Unlike other types of epidurals that spread medication broadly across the spinal canal, TFESI is site specific. It is very targeted. To ensure doctors medicate the right location, real-time fluoroscopy is brought to bear. Fluoroscopy is a specialized form of X-ray that helps guide the needle to the exact location a doctor is targeting.
Once injected, the anesthetic provides some measure of immediate pain relief. Meanwhile, the corticosteroids do two things: they begin reducing inflammation while also flushing out chemical irritants.
3 Types of TFESI Procedures
With the basic explanation out of the way, it’s time to get to the three types of TFESI procedures. It is important to note that the exact procedure is chosen based on where nerve compression occurs along the spine. Here are the three types:
1. Cervical Transforaminal Epidural Injections
Cervical TFESI concentrates on the C1 to C7 region of the neck. It’s normally recommended to treat cervical radiculopathy, herniated cervical discs, and cervical spinal stenosis. Sharp and burning pains typify all three conditions, along with numbness and weakness. The procedure’s main benefit is its ability to provide precision relief.
2. Thoracic Transforaminal Epidural Injections
Thoracic TFESI targets the mid-back region, particularly the T1 to T12 areas of the spine. Note that this procedure is not as common as the other two due to the fairly rigid nature of this part of the back. It is generally recommended for thoracic radiculopathy, thoracic disc herniation, post-herpetic neuralgia, and intercostal nerve pain that impacts the ribs and chest.
3. Lumbar Transforaminal Epidural Injections
The lower back is the main target of lumbar TFESI. It generally targets the L1 to L5 and S1 regions. It is the most commonly performed of the three TFESI procedures. Pain medicine doctors tend to recommend it for sciatica, lumbar disc herniation, lumbar spinal stenosis, and degenerative disc disease. Its primary benefits are the ability to reduce pain and restore walking tolerance and leg mobility.
Restoring function is one of the keys to both the cervical and lumbar procedures. Functional restoration is important because it reduces the risk of a person’s condition getting worse. On the other hand, lost function can create a cycle that only leads to more pain and even less function over time.
Potential Side Effects and Quality of Life
TFESI does have its potential side effects. They include mild tenderness at the injection site, temporary fluid retention, and minor infection. Although serious complications are rare, they include bleeding, localized nerve irritation, and allergic reactions.
In the end, it is really a quality-of-life issue. Is a patient willing to take the risks in order to enjoy a better life in the long term? For many people, the relatively minor risks that come with TFESI are well worth taking.