Epidural Steroid Injection (ESI)

What is an Epidural Steroid Injection (ESI)?

An epidural steroid injection (ESI) is a minimally invasive procedure used to treat pain caused by inflammation or compression of spinal nerves. It involves injecting a steroid (anti-inflammatory medication) and sometimes an anesthetic (numbing medication) into the epidural space of the spine—the area surrounding the spinal cord and nerve roots.

What are the benefits of an Epidural Steroid Injection?

An epidural steroid injection (ESI) is used to treat pain caused by inflammation or compression of spinal nerves, especially when the pain radiates from the spine into the arms or legs (called radicular pain). When patients have compression of spinal nerves, they commonly experience:
– Neck or low back pain
– Tingling or numbness
– Heaviness or aching in the hands, arms, legs or feet

Common Indications:
– Herniated or bulging discs
Disc material can press on nearby nerves, causing pain, numbness, or weakness.
– Lumbar or cervical radiculopathy (sciatica or arm pain)
Pain radiating down the arm(s) or leg(s)
– Spinal stenosis
Narrowing of the spinal canal or foramina can compress nerves.
– Degenerative disc disease
Inflammation from disc breakdown may irritate surrounding nerves.
– Post-surgical back pain (failed back surgery syndrome)
ESI may help reduce inflammation and manage residual or recurrent pain.
– Annular Tear
A small tear in the outer disc layer can leak inflammatory substances that irritate nearby nerves.

How does an Epidural Steroid Injection work?

An epidural steroid injection (ESI) works by delivering anti-inflammatory medication directly into the epidural space—the area around the spinal cord and nerves—to reduce inflammation and relieve pain caused by irritated spinal nerves.

How to prepare for an Epidural Steroid Injection?

The first step to determine your eligibility to receive an epidural steroid injection is to perform a thorough physical examination and carefully consider your medical and family history. This step is particularly crucial as steroids may temporarily elevate blood sugar levels in people with diabetes and affect patients with bleeding problems.

-Blood thinners (e.g., aspirin, Plavix, Eliquis, warfarin):
You will need to stop them before the procedure to reduce bleeding risk. Only do this under medical supervision.
-Diabetes
Steroids can temporarily raise blood sugar levels. Adjustments may be needed.
– Medical Clearance (if needed)
If you have heart conditions, bleeding disorders, or infections, your provider may require clearance from your primary doctor or specialist.

What to expect after the procedure?

Epidural steroid injections are usually performed in under 20 minutes with the patient’s ability to go home the same day after a short recovery period. If anesthetic medicine was used, the patient may have numbness immediately after the injection but will dissipate in a matter of hours. We do not recommend that you drive or do any strenuous activity for the first 24 hours after the procedure. Patients who have this type of procedure often experience early relief, but this is typically the result of the anesthetics. Once this wears off, it can take 2 to 3 days for the steroids to take effect and provide long-term relief.