Transforaminal vs. Interlaminar Epidural Injections: Which Is Right for You?

Understanding Epidural Injections for Back Pain

Chronic back pain and leg pain (sciatica) often stem from irritated or compressed spinal nerves. Whether caused by a herniated disc, spinal stenosis, or degenerative disc disease, this inflammation can severely limit your mobility and quality of life.

Epidural steroid injections (ESIs) are one of the most effective non-surgical pain management treatments available today. They deliver anti-inflammatory medication directly into the spine’s epidural space to reduce nerve irritation, relieve pain, and restore function.

However, not all epidural injections are the same. Two of the most common and effective approaches are transforaminal and interlaminar epidural injections. Understanding the differences between these techniques can help you and your physician decide which option best suits your specific condition.

What Is a Transforaminal Epidural Injection?

A transforaminal epidural steroid injection (TFESI) targets the exact area where a spinal nerve exits the spine (the neural foramen). This approach allows the medication to be placed very close to the affected nerve root, making it ideal for patients with nerve compression or inflammation due to a herniated disc or spinal stenosis.

How It Works:

• Your pain specialist uses fluoroscopic (X-ray) guidance to accurately position a thin needle into the foraminal space near the irritated nerve.
• A contrast dye confirms precise needle placement.
• Then, a combination of steroid and local anesthetic is injected directly into the nerve root area.

Best Candidates for Transforaminal Injections:

• Herniated or bulging discs
• Sciatica or leg pain caused by nerve compression
• Unilateral (one-sided) pain radiating from the lower back
• Nerve inflammation or radiculopathy

Because the injection is so targeted, patients often experience faster and more noticeable relief, especially when the pain follows a specific nerve distribution.

What Is an Interlaminar Epidural Injection?

An interlaminar epidural steroid injection (ILESI) is a slightly different technique. Instead of targeting one specific nerve root, the medication is delivered into the posterior epidural space between two laminae (parts of the vertebrae). The medication then spreads throughout a larger section of the spinal canal.

How It Works:

• The patient lies face down while the injection area is cleaned and numbed.
• Using fluoroscopic guidance, the provider inserts the needle between the laminae and into the epidural space.
• The steroid medication is then slowly injected, allowing it to bathe multiple nerve roots in the affected area.

Best Candidates for Interlaminar Injections:

• Broad or central disc bulges
• Bilateral (both sides) pain
• Chronic inflammation across multiple spinal levels
• Diffuse lower back pain not localized to one nerve root

This approach is especially useful for patients who need widespread pain relief or have generalized inflammation rather than pinpoint nerve compression.

Comparing the Two Techniques

Both transforaminal and interlaminar epidural injections are valuable tools in pain management, but they differ in precision, coverage, and patient goals.

At Greater Austin Pain Center, our providers determine which approach is best after reviewing your imaging studies (like MRI or CT scans), pain pattern, and previous treatment response.

The Procedure: What to Expect

Both types of epidural injections follow a similar process:

Before the Injection

• Your provider will review your medical history, allergies, and medications.
• If you take blood thinners, you may need to pause them under medical supervision.
• You’ll need someone to drive you home after the procedure.

During the Injection

• You’ll lie face down on a procedure table.
• The skin is cleaned and numbed.
• Using fluoroscopy, your physician will guide a thin needle into the correct epidural space.
• Once placement is confirmed, the steroid and anesthetic mixture is injected.

The entire process typically takes 10–20 minutes, and you can usually return home the same day.

After the Injection

• Mild soreness at the injection site is common for 24–48 hours.
• Some patients feel immediate relief from the anesthetic, while others notice gradual improvement over several days.
• Your provider may recommend rest for the remainder of the day and a gradual return to normal activity.

Benefits of Epidural Steroid Injections

Both transforaminal and interlaminar injections offer multiple benefits for patients struggling with back pain:

• Non-surgical relief from chronic pain
• Reduced inflammation around irritated spinal nerves
• Improved mobility and function
• Ability to participate more effectively in physical therapy
• Potential to delay or avoid spine surgery

For many patients, these injections are an essential part of a comprehensive pain management plan that includes physical therapy, medication management, and lifestyle modifications.

Risks and Safety Considerations

When performed by an experienced pain management specialist, epidural injections are effective and well-tolerated. However, as with any medical procedure, there are small risks, including:

• Temporary numbness or weakness
• Mild headache or soreness
• Rare allergic reactions or infection
• Elevated blood sugar (in diabetic patients)

At Greater Austin Pain Center, every epidural injection is performed using real-time fluoroscopy to ensure accuracy, minimize risk, and deliver medication exactly where it’s needed.

How to Choose the Right Type for You

Choosing between a transforaminal and interlaminar epidural injection depends on several factors:

• Your diagnosis (herniated disc, stenosis, degenerative changes)
• Location and pattern of pain
• Previous imaging results
• Response to prior treatments

During your consultation, your provider will discuss your symptoms, review your imaging, and determine which approach offers the best balance of precision, safety, and effectiveness.

Advanced, Personalized Care at Greater Austin Pain Center

At Greater Austin Pain Center, we understand that every patient’s pain journey is unique. That’s why we customize every treatment plan choosing the right injection technique, medication type, and follow-up strategy to help you find lasting relief.

Our team of experienced pain specialists provides compassionate, evidence-based care using the latest technology in interventional pain management.

Take the First Step Toward Relief

If chronic back or leg pain is limiting your life, you don’t have to live with it. Our team can help identify the cause and recommend the most effective, minimally invasive treatment options including transforaminal and interlaminar epidural injections.

At Greater Austin Pain Center, our experienced pain management team provides personalized, evidence-based treatments designed to help you move, work, and live more comfortably.

Schedule your consultation today at one of our convenient locations in Austin, Kyle, San Marcos, or Dripping Springs. Together, we can find safer, more effective solutions for lasting pain relief.