Continue your life with no interruptions: Stop the pain resulting from a herniated disk with “TESI” transforaminal epidural steroid injections

September 17, 2020
If you were to ask a person suffering from a herniated disk to describe the levels of pain they feel, they would most likely respond that the pain is nothing short of torturous, rendering them incapable of carrying out their daily activities without being in unbearable pain most days. Some of these patients have a passion for sports, exercises or other physical activities that have been forcibly put on hold due to the herniated disk, which has severely impacted their every move.

Withawin Kesornsak, M.D. (Dr. Khem) has informed us that herniated disk disorders are not usually considered dangerous and can be treated successfully without surgery. Some patients come to see a doctor after using an incorrect technique when lifting a heavy object, while others complain of pain after consistently sitting with poor posture or due to a fall that impacted the spine. All of these are common factors behind the onset of a herniated disk. Furthermore, there is another condition known as spinal stenosis that is also capable of causing intense back pain. However, this disorder originates from a gradual narrowing of the spaces between the spinal column and is more common among the elderly as part of the aging process.

Understanding herniated disks

Located between the hard vertebrae of the spine, softer cushions known as disks serve the role of keeping the spine flexible and capable of slight movements. Acting as a shock absorber, these disks are rubbery like an eraser on the outside but consist of more flexible, jelly-like tissue internally. When the outer tissue of a disk becomes torn, a hole appears that allows the inner substance to leak out. Any decrease in cushioning or narrowing between the vertebrae places pressure on the surrounding nerves and increases inflammation causing intense pain for the sufferer.

Can the condition be dangerous if left untreated?

The body’s immune system is actually capable of resolving a herniated disk naturally, taking approximately 4-6 weeks to do so. However, because of the intensity of the pain and the impact upon a person’s daily functioning, including work life and mental stress, treatment for this disorder is highly recommended. It can speed recovery time returning one to their normal life prior to this condition.

How can you stop the pain?


There are many forms of treatment for disk herniation. However, any treatment must only be carried out by a highly trained doctor who specializes in spinal disorders. When attending a consultation, patients will be asked about their medical history before undergoing a physical examination and having an MRI scan. Analyzed results ensure the subsequent course of treatment can be as successful as possible.

Doctors will usually prescribe pain relief medication alongside physical therapy initially. However, where such courses are unsuccessful or where the pain intensifies, doctors may instead turn to a transforaminal epidural steroid injection (TESI). Surgery may be considered if the aforementioned forms of treatment have been unsuccessful or in cases where the pressure placed on the spinal column results in severe muscle weakness that affects the patient’s ability to lead a normal life, such as being incapable of walking or in cases of nerve deterioration.

Patients would be considered an urgent case requiring emergency surgery if they experience any of the following symptoms:
  • Inability to urinate or pass stool
  • Lacking sensation in the buttocks
  • Experiencing erectile dysfunction

What conditions can be treated using transforaminal epidural steroid injections?

This method of treatment can be used to treat both herniated disks and spinal stenosis. However, success rates are higher when it is used to treat herniated disks owing to the fact that the condition can be resolved by decreasing inflammation using medication placed right at the source.

Does it hurt?

The pain felt during the procedure is minimized as a local anesthetic is first injected into the area prior to the steroid injection(s). For patients afraid of needles, a light sedative might be prescribed so the patient is relaxed prior to the procedure.

How long does the procedure take?

The procedure takes place in a sterile operating theatre and the length of time required to complete the process depends on the individual. In cases where the conditions are not complex, doctors may be able to complete the procedure in a mere 15-20 minutes. Complicated cases where patients are treated for multiple damaged locations may take approximately 30 minutes to complete.

Are there any physical side effects associated with receiving steroid injections?

The nature of these steroid injections means the medication is confined to the herniated disk area. As a result, there are far fewer potential side effects — including slightly raised blood pressure or blood sugar levels for approximately 1-2 weeks — than there would be for orally administered steroids.

Are repeat injections necessary?

Herniated disks are usually resolved by the body naturally, the injections help to alleviate the pain while the body goes to work on fixing the issue. Hence, patients generally see their symptoms disappear for good after one injection. Patients must exercise extreme caution when performing various tasks, especially lifting heavy objects, as the injury can worsen in severity if not given the appropriate time to heal.

What are the success rates for this type of treatment and what risks are involved?

The chances of success depend on the individual as each herniated disk is unique. Doctors will assess the likelihood of success and will always inform patients of their expectations regarding treatment outcomes. Should the pressure being placed on the spinal column be severe, minimally invasive surgery may offer a greater chance of success. As far as risks transforaminal epidural steroid injections are concerned, they are minimal when the injections are performed by a highly trained medical professional, with Bumrungrad International Hospital responsible for approximately 500-600 TESI procedures per year.

Preparing for the procedure

Any medication you are taking should be brought to the attention of your doctor. Any medications that can thin the blood “anticoagulants” should be halted prior to the procedure taking place. This includes food supplements and vitamins that impact blood clotting capabilities, such as vitamin E and fish oils, aspirin, and anticoagulants.

Precautions following the procedure

In order to ensure the longevity of any pain relief, patients should avoid any heavy lifting, high-impact activities or physical exercise involving rapid and sudden changes of direction.

Continue your life with no interruptions: Stop the pain of a herniated disk at Bumrungrad International Hospital

At Bumrungrad, our highly trained team of specialists are able to provide accurate diagnoses and prescribe a comprehensive range of treatments for patients suffering from problems related to a herniated disk. Working alongside these specialists, our interdisciplinary teams have undergone specific training and are highly experienced in dealing with patients suffering from the disorder. Bumrungrad International Hospital is fully committed to providing the highest levels of healthcare in an open and caring manner. We therefore ensure our patients have adequate time to understand their suggested course of treatment in order to allow them to make appropriate plans, with the shared aim of enabling a rapid return to their former lives and the physical activities they enjoy the most.

By Dr. Withawin Kesornsak, Spine Surgeon, Spine Institute, Bumrungrad International Hospital
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