Epidural Steroid Injection (ESI)


The epidural space is between the dural sac (a membrane encasing the spinal cord, spinal fluid and nerve roots) and the vertebral wall. An epidural steroid injection (ESI) is an injection that delivers long-acting steroids directly into the epidural space. The steroids help to reduce pain by reducing inflammation around the nerves. Sometimes an anesthetic or saline is also used to help “flush out” inflammatory agents that may be irritating a nerve. 

Epidural steroid injections are typically used to treat pain radiating from the lower back into the legs or from the neck into the arms. The diagnoses most often considered for ESI are herniated disc, stenosis, nerve root compression and, in some cases, spondylolisthesis.

Before the Procedure

  • Do not eat or drink anything after midnight before your injection.
  • You can take your regular heart and blood pressure medications on the morning of the injection with a sip of water. Check with your doctor regarding taking diabetes medications prior to the injection.
  • Discontinue taking anti-inflammatories three days before the injection.
  • Discontinue taking aspirin products and other blood thinners seven days before the injection.
  • If on blood thinners, call the physician who prescribed the medication to get approval to stop taking them before the injection.

During the Procedure

  • The patient lies flat on his/her abdomen on an x-ray table.
  • The skin is numbed with lidocaine.
  • Using fluoroscopy (live x-ray) for guidance, the physician directs a needle toward the epidural space. Fluoroscopy is considered important so that the physician can more easily determine if the needle is in the right place.
  • The steroid solution is injected (you may feel heaviness and/or numbness in your legs caused by the anesthetic). This generally lasts only a few hours.
  • An epidural steroid injection usually takes between 15 and 30 minutes.

After the Procedure

  • Following the injection, the patient is usually monitored 15 to 20 minutes before being discharged to go home.
  • It is important that the patient have someone drive him/her home after the injection.
  • Patients are usually asked to rest on the day of the injection.
  • Normal activities (i.e., those that were done the week prior to the injection), including work, may typically be resumed the following day. Please note that your back may be sore for 24 to 48 hours.
  • Patients shall avoid heat pads, hot tubs, and commercial topical heating rubs for 48 to 72 hours. Icing over the injection site is recommended.
  • There is no definitive research to dictate how often a patient should have epidural steroid injections. In general, it is considered reasonable to perform up to four epidural steroid injections per year. The decision to do a series of injections is usually based on the patient’s response to the first injection.

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