Epidural Steroid Injections

What Are Epidural Injections?

Epidural steroid injections (ESIs) deliver anti-inflammatory medication directly into the epidural space around the spinal nerves. They're one of the most common interventional procedures for back and neck pain, particularly when pain radiates into the arms or legs due to nerve irritation.¹

How They Work²

Steroid reduces inflammation around nerves
Local anesthetic provides immediate relief
Targets specific area of spine
May reduce nerve swelling and irritation
Allows natural healing to occur

Conditions Treated

Herniated disc
Spinal stenosis
Sciatica
Degenerative disc disease
Radiculopathy (nerve root pain)
Spondylolisthesis

Types of Approaches

Interlaminar

Enters between vertebrae
More general spread
Good for midline pain

Transforaminal

Enters through nerve opening
More targeted to specific nerve
Often used for leg/arm pain

Caudal

Enters through sacrum
Used for lower spine issues
Less precise targeting

What to Expect³

Before

Review medications with doctor
May need to stop blood thinners
Arrange for driver home

During

Usually done under fluoroscopy (X-ray)
Takes 15-30 minutes
Positioned face down
Skin numbed first
Pressure sensation during injection

After

Observation for 15-30 minutes
Rest day of procedure
May have temporary leg weakness
Full effect in 2-7 days

Effectiveness

50-75% experience some relief
Relief duration varies widely
Some get weeks, others months
May be repeated if helpful
Usually limit 3-4 per year

Risks

Temporary pain increase
Headache
Infection (rare)
Bleeding (rare)
Nerve damage (very rare)
Steroid side effects (with repeated use)

References

Manchikanti L, Nampiaparampil DE, Manchikanti KN, et al. Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections. Pain Physician. 2015;18(5):E535-582.
Benny B, Azari P. The efficacy of lumbosacral transforaminal epidural steroid injections. Curr Opin Anaesthesiol. 2011;24(5):519-526.
Manchikanti L, Boswell MV, Singh V, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician. 2009;12(4):699-802.