TFESI Outcomes For Lumbar Disc Herniations Remain Inconsistent in Review

Predicting Response to Transforaminal Epidural Steroid Injections

For patients suffering from lumbar disc herniations, the effectiveness of transforaminal epidural steroid injections (TFESI) has long been a subject of clinical scrutiny. The research highlights a persistent lack of uniformity in how practitioners evaluate success, with studies utilizing varying tools including the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), the Numeric Rating Scale (NRS), and the Patient’s Global Impression of Change (PGIC).

The studies included in the review varied significantly in their design, including large variances in follow-up intervals, TFESI techniques, medication selection, and pre- and post-procedural assessments. Regarding the evaluation tools, the review notes that VAS and NRS are relatively simple self-reporting tools utilizing visual facial representations and numeric values for subjective pain measurement. The PGIC is described as slightly more nuanced, aiming to detect subjectively significant improvement, while the ODI is considered the most robust, assessing lifestyle domains such as sleeping, standing, sitting, and social life.

Evidence Regarding Disc Herniation Location

The review found that three of the 13 studies—conducted by Veljanovski et al., Lee et al., and Lechman et al.—reported statistically significant pain relief in cohorts with lateral or far lateral disc herniations compared to patients with central herniations. Veljanovski et al. and Lee et al. represented this difference through significant changes in VAS measures pre- and post-procedure. Lechman et al. demonstrated this through significant differences in NRS and PGIC scores. Additionally, the review noted that Veljanovski et al. included non-disc herniation pathology, such as central canal stenosis, in their study design, but observed no statistically significant findings of improvement in those patients.

Two additional studies, conducted by Serifoglu et al. and Evran et al., suggested significant improvements in pain measures among far lateral disc herniation cohorts, though the review noted these were limited by a lack of control comparisons across different anatomic zones. Conversely, the level of pathology, such as L4/5 versus L5/S1, was not found to have a significant effect on results.

Conflicting Evidence and Long-term Data

The 2026 review highlights a significant divide in the medical literature. Six of the 13 studies—including research by Kim et al., Ekedahl et al., Tecer et al., Choi et al., Jung et al., and Kwak et al.—found no statistically significant difference in outcomes based on the anatomic location of the disc herniation. Most of these studies evaluated injections at one to three months post-procedure.

The study by Kwak et al. serves as a notable outlier, as it analyzed patient outcomes a minimum of 4 years after the procedure. In that study, the primary predictor of success was whether the disc herniation was protruded rather than extruded, rather than its location. However, the review notes that foraminal and extraforaminal disc herniations did show reductions in NRS scoring 4 years post-procedure. Choi et al. also drew mixed conclusions, noting an association with better outcomes in more lateral zones, though this was based on limited data.

Frontal Pneumosinus Dilatans and Flight-Related Pain

The contrast between these areas of research underscores the necessity of personalized clinical assessment. Patients experiencing persistent pain or symptoms are encouraged to consult their healthcare provider to discuss appropriate diagnostic pathways and treatment options based on their individual clinical profile.

Sources: Cureus, link.springer.com.