What to know about an epidural steroid injection

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An ESI is a nonsurgical treatment for pain relief. It can help treat lower back pain that radiates to the lower body and sometimes neck pain that may radiate down to the arms.

A doctor will inject a steroid, which aims to reduce inflammation and relieve pain, into the epidural space. The epidural space is an area of fat and blood vessels within the spinal canal. It surrounds the spinal cord and protects the spinal cord and spinal nerves from damage.

An ESI may help people return to their everyday activities or physical therapy. The procedure may offer short- or long-term benefits.

People may be suitable candidates for ESIs if they have inflammation of the spinal nerves. This can cause lower back pain, which can radiate down through the legs, or neck pain, which can radiate to the arms.

Certain conditions, such as spinal stenosis, may cause the nerve passages to become narrower, which can cause pain and lead to inflammation of the spinal nerves.

People who may be unsuitable candidates for an ESI include those with:

• an infection in the bloodstream or at the site of injection
• a condition that increases the risk of bleeding
• severe allergic reaction to anesthetics, contrast dye, or corticosteroids
• cancer affecting the injection site
• uncontrolled diabetes
• congestive heart failure
• pregnancy, due to fluoroscopy imaging

ESIs may be a suitable treatment option for people with nerve root pain due to the following conditions:

• radiculitis
• sciatica
• herniated disc
• degenerative disc disease
• spinal stenosis, which may occur from spinal arthritis
• bone spurs
• spondylolysis
• spondylolisthesis
• thickening of the ligamentum flavum, a ligament that connects vertebrae
• scoliosis that causes irritation of the spinal nerve roots
• post-laminectomy syndrome
• compression fracture
• damage to nerve fibers following shingles or injury
• cysts on the nerve roots

A team of healthcare professionals will be involved in providing an ESI. These may include:

• a doctor with specific training in delivering ESIs, such as an orthopedic surgeon, physiatrist, or radiologist
• a nurse or assistant
• a radiologist to operate the fluoroscopy
• an anesthesiologist

ESI is usually an outpatient procedure, meaning people will only need to be in the healthcare facility for the length of the procedure. Therefore, they can return home after the injection.

Before an ESI procedure, the following may happen:

• People will need to discuss any medical conditions, medications, or allergies with a doctor to check if they need to take any extra measures before an ESI.
• On arrival at the healthcare facility, people may need to change into a surgical gown, as this can make it easier to deliver the injection.
• A doctor may give the patient a mild sedative or local anesthetic.

To carry out an ESI, a doctor may do the following:

• use an X-ray to create a moving image to follow to guide the needle into the right position
• use contrast dye at the injection site to ensure the steroids go into the right location
• inject the steroid into the epidural space, usually alongside a local anesthetic for pain relief

Depending on the condition, there are different types of ESI:

• Interlaminar: A doctor will inject the steroid into the back, into the middle of the spine.
• Transforaminal: A doctor will inject the steroid into an affected spinal nerve root.
• Caudal: A doctor will inject the steroid into the lower back.

People will be able to return home after the completed procedure. They will usually be able to resume everyday activities the following day. Individuals will also need to follow any aftercare instructions from a healthcare professional.

People may begin to feel the benefits of an ESI within 1–3 days or a week.

If side effects occur after an ESI, they may include:

• flushing of the face and chest
• increased temperature
• sleeping problems
• changes in the menstrual cycle
• water retention
• anxiety
• pain that may increase in the days following the procedure, although this is rare

Rare bleeding complications include:

• an allergic reaction
• infection
• nerve damage
• numbness or tingling
• epidural bruising or abscess
• temporary pain in the back or lower limbs
• adrenal suppression
• postdural puncture headache
• paralysis, but this is very rare

There is some research that suggests that ESIs may cause bone loss and increase the risk of fractures, although researchers need further evidence to confirm these findings.

An ESI may result in several months of improved function and pain relief. If an ESI effectively improves symptoms, people may have a repeat procedure as the effects wear off. If the procedure does not provide pain relief, it may indicate that another issue is causing symptoms.

An ESI can be a safe and effective form of pain relief for many conditions affecting the spinal nerves. Although the technique is not a cure, it may help relieve pain and improve quality of life.

The duration and level of pain relief may vary for each person, depending on their individual condition. Other steps may help alongside an ESI to manage chronic pain conditions, such as:

• regular exercise and staying physically active
• maintaining a moderate weight
• eating a balanced diet
• avoiding or quitting smoking, if applicable

An ESI may help relieve pain and reduce inflammation in certain conditions affecting the spinal nerves, such as spinal stenosis, herniated disc, or sciatica.

A doctor will inject a steroid into the epidural space to relieve inflammation and pressure on the spinal nerves.

An ESI is an outpatient procedure, so people will be able to return home afterward. They will usually be able to return to typical activities the following day. Individuals may begin to feel the benefits of an ESI in the days following the procedure.

An ESI may help improve pain and function for weeks or months. People may be able to have a repeat procedure when the effects wear off.