What Is a Cervical Transforaminal Epidural Steroid Injection?

A cervical transforaminal epidural steroid injection (TFESI) is a targeted, image-guided procedure used to treat neck pain and radiating arm pain caused by irritation or inflammation of a cervical spinal nerve.

In the cervical spine (neck), nerves exit through small openings called foramina. When a disc bulges, degenerates, or when bone spurs narrow these openings, the nerve can become inflamed. This often leads to symptoms such as:

• Pain radiating into the shoulder or arm

• Numbness or tingling in the arm or fingers

• Burning or electric-type pain

• Weakness in the arm or hand

A cervical TFESI delivers anti-inflammatory medication directly around the irritated nerve root to reduce swelling and calm inflammation at its source.

How the Procedure Works:

The procedure is performed in an outpatient setting using live X-ray guidance (fluoroscopy) to ensure precise needle placement.

During the injection:

1. You lie comfortably on an X-ray table.

2. The skin is cleaned and numbed.

3. A thin needle is guided into the neural foramen next to the affected cervical nerve.

4. Contrast dye confirms accurate placement.

5. A small amount of corticosteroid (anti-inflammatory medication), often combined with a local anesthetic, is injected around the nerve.

Because the medication is delivered directly to the specific inflamed nerve, this approach allows for highly focused treatment compared to broader epidural techniques.

The procedure typically takes 15–30 minutes, and most patients go home the same day.

What Conditions Can It Help?

Cervical TFESIs are commonly used to treat:

• Cervical disc herniation

• Foraminal stenosis (nerve narrowing)

• Cervical radiculopathy (“pinched nerve”)

• Degenerative disc disease in the neck

• Bone spur–related nerve irritation

This injection is particularly helpful when symptoms radiate into the arm, shoulder blade, or hand.

What to Expect After the Injection:

Some patients notice immediate short-term relief from the local anesthetic. The steroid medication may take several days to a couple of weeks to reach its full effect.

Relief can last weeks to months, depending on the underlying condition. In many cases, pain reduction allows patients to:

• Decrease reliance on oral pain medications

• Participate more effectively in physical therapy

• Improve function and activity tolerance

While some patients experience long-term relief, others may require repeat injections as part of a broader treatment plan.

Risks and Safety:

When performed by experienced spine specialists under image guidance, cervical TFESIs are generally safe. However, as with any medical procedure, there are potential risks, including:

• Temporary increase in pain

• Headache

• Dizziness

• Temporary numbness or weakness

• Elevated blood sugar (in patients with diabetes)

• Bleeding or infection (rare)

• Nerve or vascular injury (rare but serious)

Because the cervical spine contains critical nerves and blood vessels, precision and experience are essential. At our practice, all injections are performed with imaging guidance to maximize safety and accuracy.

How Often Can Cervical TFESIs Be Performed?

Steroid exposure is carefully monitored. Most patients receive no more than several injections per year, depending on response and overall health considerations. Your physician will determine the safest and most appropriate schedule for you.

Is This Right for You?

Cervical transforaminal epidural steroid injections are often recommended when:

• Neck pain radiates into the arm

• Conservative treatments (medications, therapy, activity modification) have not provided sufficient relief

• Imaging confirms nerve compression

These injections are typically part of a comprehensive treatment strategy aimed at improving function and quality of life while avoiding or delaying surgery when possible.

Reference:

Available at Cleveland Clinic: “Transforaminal Epidural Steroid Injections.”