Lumbar Transforaminal Epidural Steroid Injection (TFI)

 

Acute Lower Back and Leg Pain 

The lumbar discs are vulnerable to injury; heavy lifting, sustained bending and repetitive bending are frequently associated with disc trauma and subsequent disc prolapse.  Sometimes disc protrusions can result from minor events such as bending over to pick up light objects. 

Lumbar disc protrusions may be large enough to irritate spinal nerves, leading to pain in the lower back with extension down one or both legs.  This is called referred pain and is sometimes referred to as sciatica.  

The leg pain may be severe and shooting down the leg, occurring with movement or may be spontaneous, this is called radicular pain.  Sometimes there may be pins and needles, tingling or a burning sensation associated with this pain.  Rarely, there may be weakness of the affected leg, particularly the ankle, foot or toe.  Loss of bladder and/or bowel control requires urgent medical attention.

Treatment

Most people with back and leg pain can be managed by their general practitioners, physiotherapist, chiropractors, osteopaths.  Most will improve with pain killers and manual treatment. 

However, if despite adequate pain relief and physical treatments, the pain, particularly leg pain, remains severe and debilitating, then further review is required.  

Up to 20% of those with back and leg pain may require surgery, but for most, continued pain relief, continued manual treatment (if helpful), and the addition of a lumbar transforaminal epidural steroid injection (TFI), will be adequate in settling the back and leg pain.

Lumbar Transforaminal Epidural Steroid Injection (TFI) 

Before a TFI is completed, an MRI will be requested.  This is important to confirm the diagnosis and to help with planning for the procedure.  The TFI is completed in theatre under special x-ray guidance to ensure accuracy and safety. 

The procedure is helpful in at least 70% of patients.  The steroid reduces pain, inflammation and swelling.  Sometimes a second or rarely a third injection is required, but this is unusual.  The steroid injection can be effective even 12 months or more after the onset of symptoms. 

When the procedure is completed, in accordance with the Spine Interventional Society (SIS Guidelines), serious complications have not been recorded.  I follow carefully the SIS Guidelines.  

If conservative care including TFI have not significantly improved back and leg pain, then surgery can be considered.  A TFI does not adversely affect having surgery.