Epidural Steroid Injections

Epidural steroid injections (ESIs) are a standard treatment option for many forms of low back pain and leg pain. They have been used since 1952 and are an integral part of the treatment for sciatica and low back pain. The goal of the injection is pain relief.

There are different types of epidural steroid injections, depending on location and approach. Examples are:

• Cervical Epidural Steroid Injections
• Transforaminal Epidural Steroid Injections
• Caudal Epidural Steroid Injections
• Thoracic Epidural Steroid Injections
• Lumbar Epidural Steroid Injections

How does it work?

An epidural steroid injection delivers steroids directly into the epidural space in the spine. Typically, a solution containing cortisone (steroid) with local anesthetic (lidocaine and saline is used.

• A steroid is usually injected as an anti-inflammatory agent. Inflammation is a common component of many low back conditions, and reducing inflammation helps reduce pain. Triamcinolone acetonide, Dexamethasone, and Betamethasone are commonly used medications.
• Lidocaine (also referred to as Xylocaine) is a fast-acting local anesthetic used for temporary pain relief. These local anesthetics also act as 'flushing' agents to dilute the chemical or immunologic agents that promote inflammation.

How is it done?

• The patient lies flat on an X-ray table or with a small pillow under their stomach to slightly curve the back or neck.
• The low back area's skin is cleaned and then numbed with a local anesthetic similar to what a dentist uses.
• Using fluoroscopy (live X-ray) for guidance, a needle is inserted into the skin and directed toward the epidural space. Fluoroscopy is considered necessary in guiding the needle and placing it in the correct position.
• Once the needle is in the proper position, contrast is injected to confirm the needle location, and the spread is noted. The epidural steroid solution is then injected. Most patients only feel some pressure in the back and sensation down the leg.
• The patient is monitored for 15 minutes and then sent home.

How many injections can be done?

After the initial evaluation and review of the MRI, the Patient is scheduled for only one injection and then seen in 2 weeks for a follow-up visit. If no relief is noted, then no more injections are planned unless the level is changed. If partial relief is noted, then two more injections can be done over 6 to 8 weeks. We limit the number of injections to 4/year to avoid the side effects of the steroid.

How long does the relief last?

Every patient has a different type of spinal problem, so everyone has a different response to the injection. Relief can be temporary or last for several months. There is no way to predict the duration.

Educational Videos

Learn more about epidural steroid injections by watching these educational videos.

• Caudal Epidural Steroid Injection
• Lumbar Transforaminal Epidural Steroid Injection
• Epidural Steroid Injection (ESI) in the Cervical Spine