Lumbar Transforaminal Epidural Corticosteroid Injections

  • Nicholas J. BremerEmail author
  • Mark N. Malinowski


Lumbar transforaminal access has the ability to both diagnose neuropathic and alleviate pain. Known by several names, the transforaminal epidural corticosteroid injections (TFESIs) can be of great utility in diagnosing and treating neuronal pain. Targeting specific nerve root levels with high-dose medication is valuable both from a diagnostic and therapeutic perspective. This chapter provides a context for the use of this technique in the pain treatment algorithm. Patient selection, indications, and contraindications will be discussed to include reference to the most recent anticoagulation guidelines. Lastly, the procedural technique will be discussed to include alternative approaches.


Epidural steroid injection Transforaminal epidural steroid injection Selective nerve root block Transforaminal access 

Recommended Reading

  1. 1.
    Acarolglu E, Nordin M, Randhawa K, Chou R, Cote P, Mmopelwa T, Haldeman S. The Global spine care initiative: a summary of the guidelines on invasive interventions for the management of persistent and disabling spinal pain in low - and middle-income communities. Eur Spine J. 2018; epublished Scholar
  2. 2.
    Bogduk. Practice guidelines for spinal and diagnostic and treatment procedures 2nd Edition. San Francisco: International Spine Intervention Society; 2013. p. 459–557.Google Scholar
  3. 3.
    Buenaventura RM, Datta S, Abdi S, Smith HS. Systematic review of therapeutic lumbar transforaminal epidural steroid injections. Pain Physician. 2009;12(1):233–51.PubMedGoogle Scholar
  4. 4.
    Chang M, Lee D. Outcome of transforaminal epidural steroid injection according to the severity of lumbar foraminal spinal stenosis. Pain Physician. 2018;21:67–72.PubMedGoogle Scholar
  5. 5.
    Feeley I, Healy E, Noel J, Kiely P, Murphy T. Particulate and non-particulate steroids in spinal epidurals: a systematic review and meta-analysis. Eur J Spine. 2017;26:336–44.CrossRefGoogle Scholar
  6. 6.
    Fenton D, Czervionke L. Image-guided spine intervention. Philadephia: Saunders; 2013. p. 73–126.Google Scholar
  7. 7.
    Leung S, Chau W, Law S, Fung K. Clinical value of transforaminal epidural steroid injection in lumbar radiculopathy. Hong Kong Med J. 2015;21(5):394–400.PubMedGoogle Scholar
  8. 8.
    Liu J, Zhou H, Lu L, Li X, Jia J, Shi Z, Yao X, Wu Q, Feng S. Effectiveness of transforaminal versus caudal routes for epidural steroid injections in managing lumbosacral radicular pain. A systematic review and meta-analysis. Medicine. 2016;95(18):1–11.Google Scholar
  9. 9.
    Lutz GE, Vad VB, Wisneski RJ. Fluoroscopictransforaminal epidural steroids: an outcome study. Arch Phys Med Rehabil. 1998;79:1362–6.CrossRefGoogle Scholar
  10. 10.
    Makkar J, Singh P, Jain D, Goudra B. Particulate versus non-particulate steroids for transforaminal epidural steroid injections: a systematic review and meta-analysis of the current literature. Pain Physician. 2016;19:327–40.PubMedGoogle Scholar
  11. 11.
    Manchikanti L, Hirsch J. Neurological complications associated with epidural steroid injections. Curr Pain Headache Rep. 2015;19:1–10.CrossRefGoogle Scholar
  12. 12.
    Manchikanti L, Buenaventura RM, Manchikanti KN, Ruan X, Gupta S, Smith HS, Christo PJ, Ward SP. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician. 2012;15(3):E199–245.PubMedGoogle Scholar
  13. 13.
    Manchikanti L, Kaye A, Manchikanti K, Boswell M, Pampati V, Hirsch J. Efficacy of epirdural steroid injections in the treatment of lumbar central spinal canal stenosis: a systematic review. Anesth Pain Med. 2015;5(1):1–15.CrossRefGoogle Scholar
  14. 14.
    Mehta M, Salmon N. Extradural block: confirmation of the injection site by x-ray monitoring. Anaesthesia. 1985;40:1009–12.CrossRefGoogle Scholar
  15. 15.
    White AH, Derby R, Wynne G. Epidural injections for diagnosis and treatment of low back pain. Spine. 1980;5:78–86.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Center for Pain Relief, Spine and Nerve Centers of the VirginiasCharlestonUSA
  2. 2.Adena Spine CenterChillicotheUSA

Personalised recommendations