Epidural Steroid Injections

What Are Epidural Steroid Injections?

Epidural steroid injections (ESIs) deliver corticosteroid medication into the epidural space around the spinal nerves. The steroid reduces inflammation, which can relieve pain from nerve irritation. They're commonly used for radicular pain (sciatica) from disc herniations or spinal stenosis.¹

Types of Approaches

Interlaminar - Between vertebrae, targets central epidural space
Transforaminal - Through the foramen, more targeted
Caudal - Through sacral hiatus, often for lower lumbar

Conditions Treated²

Herniated disc with radiculopathy
Spinal stenosis
Degenerative disc disease
Post-surgical pain
Some cases of chronic back pain

The Procedure

Outpatient, takes 15-30 minutes
Local anesthesia
Fluoroscopic (X-ray) guidance
Contrast dye confirms placement
Steroid and anesthetic injected

What to Expect³

May have temporary numbness/weakness
Pain relief may take days to weeks
Duration varies (weeks to months)
Can be repeated (usually limit of 3-4/year)

Potential Side Effects

Temporary increase in pain
Headache
Elevated blood sugar (diabetics)
Facial flushing
Rare: infection, bleeding, nerve injury

References

Manchikanti L, Knezevic NN, Boswell MV, et al. Epidural injections for lumbar radiculopathy and spinal stenosis: a comparative systematic review and meta-analysis. Pain Physician. 2016;19(3):E365-E410.
Chou R, Hashimoto R, Friedly J, et al. Epidural corticosteroid injections for radiculopathy and spinal stenosis. Ann Intern Med. 2015;163(5):373-381.
Benyamin RM, Manchikanti L, Parr AT, et al. The effectiveness of lumbar interlaminar epidural injections. Pain Physician. 2012;15(3):E363-E404.