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Transforaminal epidural steroid injection

Transforaminal epidural steroid injections (TFESI), also known as transforaminal nerve root injection or nerve root blocks, are performed for treatment and diagnosis of radicular pain. They differ from selective nerve root blocks (SNRB), as the aim is to get "epidural spill" and get the injectate into the epidural space. TFESI are less selective than SNRBs, which are more accurate diagnostically. 

Procedure

Preprocedure evaluation

Reviewing past imaging should aid the practitioner in technique and equipment selection. Correlating the patient's history and examination with the imaging findings is key to ensuring the correct side, level and procedure-type (e.g. epidural vs selective) is performed. 

Equipment

See spinal interventional procedures.

Technique

Fluoroscopy and CT are the most common imaging guidance methods, and technique will depend on regional preferences, practitioner preference, equipment availability, and type of injection. 

CT can be performed in those with contrast allergies, as gas can be injected instead of iodinated contrast to confirm an epidural needle tip position. 

Once a satisfactory needle tip position is obtained, a mixture of steroid and anesthetic can be injected. Nonparticulate steroids (e.g. dexamethasone) are usually preferred in TFESI to reduce the risk of vascular complications such as spinal cord infarction 1.

Complications

See spinal interventional procedures.

Interventional procedures

Article information

rID: 2194
Synonyms or Alternate Spellings:
  • Transforminal epidural steroid injection
  • Transforaminal nerve root injections
  • TFESI
  • CT guided periradicular therapy
  • Transforaminal nerve root block

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Cases and figures

  • Case 1: L5 TFESI (CT-guided)
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  • Case 2: lumbar TFESI (CT-guided)
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  • Case 3: C7 TFESI (CT-guided)
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  • Case 4: L5 TFESI (fluoroscopic guided)
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  • Case 5: L5 TFESI (fluoroscopic guided)
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  • Case 6: L5 TFESI (CT guided)
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  • Case 7: S1 TFESI (fluoroscopic guided)
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  • Case 8: intravascular needle tip in a S1 TFESI
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