As of the latest update, Google Chrome and Microsoft Edge have made a breaking change to how file uploads are handled. Once your system installs this update, you will not be able to upload new images. Please use another browser until we can get it fixed.

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. 


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. 


See spinal interventional procedures.


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.


See spinal interventional procedures.

Interventional procedures
Share article

Article information

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

Support Radiopaedia and see fewer ads

Cases and figures

  • Case 1
    Drag here to reorder.
  •  Case 2
    Drag here to reorder.
  • Case 3: cervical - C6/7
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.