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Epidural Steroid Injection: An Overview

An Epidural Steroid Injection (ESI) is a common, non-surgical pain treatment method that involves injecting steroid medication into the Epidural Space of the spine where inflamed nerves are located. Inflamed nerves caused by the narrowing of the spinal passages can cause spinal related arm or leg pain in which the ESI can reduce the inflammation and relieve pain. Epidural Steroid Injections are performed by interventional pain management specialists to relieve a variety of painful ailments anywhere in the spine.

How It Works

Narrowing of the spinal passages can occur from a variety of causes:

Bone spurs

Thickening of the ligaments in the spine,

Spondylolisthesis (“slipped vertebrae”)

Herniated discs

Joint cysts

The epidural space is the area between the dura mater and the vertebral wall containing fat and small blood vessels that provides cushioning for the nerves and spinal cord. Steroids placed into the epidural space can successfully decrease pain and allow patients to improve function. Although steroids do not change the underlying condition, they can improve pain and inflammation and allow the body to compensate for it. The epidural steroid injection is a combination of a corticosteroid (a strong anti-inflammatory medicine) and an anesthetic pain relief medicine. The combination of these medicines take a lot of pressure off the nerves and other soft tissues.

ESI is usually not given unless symptoms caused by lumbar spinal stenosis have not responded to other nonsurgical treatments. Imaging tests, such as MRI or CT scans, are usually done before you are given the injection. These tests are used to identify the exact location of where the nerve roots are being squeezed.

All the approaches to deliver the steroid into the epidural space entail placing a thin needle into position using x-ray guidance. Prior to injecting the steroid, contrast dye is used to authorize that the medication is traveling into the desired area. Local anesthetic is often added with the steroid to provide temporary relief. An interlaminar ESI involves placing the needle into the back of the epidural space and delivering the steroid over a wider area. A caudal ESI uses a small boney opening just above the tailbone to allow for needle placement into the very bottom of the epidural space. A transforaminal ESI places a needle alongside the nerve as it exits the spine and medication is placed into the “nerve sleeve” and travels into the epidural space from the side. All ESI procedures are performed on an outpatient basis, and you can usually return to your day to day activities the following day.

Side Effects

Many people don’t feel the side effects of an ESI, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine. The steroid will usually begin working within 1-3 days, but in some cases it can take up to a week to feel the benefits. Although uncommon, some patients will experience an increase in their usual pain for several days following the procedure.

Though steroids generally don’t have any harmful effects, some patients MAY experience side effects including:

“Steroid flush” (flushing of the face and chest that can last several days and can be accompanied by a feeling of warmth or even a low grade increase in temperature)


Changes in menstrual cycle

Trouble sleeping

Allergic reaction


However, these side effects are usually mild and will often resolve within a few days. If you have any serious medical conditions, discuss with your doctor prior to the injection.

Epidural Steroid Injections have been performed for many decades, and are a very safe and effective treatment for the following types of pain: upper and lower back, leg, knee, neck, arm and joint. Although not everyone obtains pain relief with ESIs, the injections can often provide you with improvement in pain and function that last several months or longer.

If you get significant benefit, the injections can be safely repeated periodically to maintain the improvements. Injections are also commonly coupled with other treatments such as medications, or physical therapy to prolong the effects. Consult with one of our physicians at any one of our 3 locations to learn more about Epidural Steroid Injections!

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