Epidural steroid injections (ESIs) are the most common injection to treat pain and
inflammation due to herniated discs and spinal stenosis. Cervical herniated discs
or cervical spinal stenosis can cause neck and arm pain. Lumbar herniated discs
or lumbar spinal stenosis can cause low back and leg pain (sciatica).
What is an epidural steroid injection?
An epidural steroid injection is an injection of corticosteroid into the epidural
space. The epidural space is inside the spinal canal, but outside the dural sac
which contains the spinal cord, nerve roots, and spinal fluid.
There are different approaches for performing epidural steroid injection:
2) Transforaminal (also known as epidural nerve block or selective nerve root block)
The approach used will depend on the clinical presentation of the patient and the
review of the patient’s spinal imaging (i.e. MRI or CT scan).
At Commonwealth Sport and Spine, we will facilitate with arranging the epidural steroid
injection. These injections are only performed under fluoroscopy (x-ray guidance)
to ensure patient safety, patient comfort, and to make sure the medication will be
delivered to the targeted area precisely.
What is involved when having an epidural steroid injection?
Before an injection, patient history and a targeted examination are performed, patient’s
spinal imaging is reviewed, risks and benefits of the procedure discussed, and signed
consent is obtained. For certain procedures, patients are asked to change into a
gown, otherwise no changing is necessary.
The patient is then taken to fluoroscopy (x-ray) suite and will lie flat on an x-ray
table. Pillows will be used to position the spine for comfort as well as to provide
optimal positioning for performing the procedure. The skin overlying the injection
site is prepped (cleaned) in a sterile fashion and then sterile drapes are placed
around the prepped area.
The skin is then numbed with a local anesthetic. Under x-ray guidance a needle is
inserted. The needle is advanced under x-ray guidance to the targeted area. X-rays
pictures from different angles are used to ensure pin-point accuracy of the needle
tip. After the needle is placed properly, a small amount of contrast is injected
to ensure that the medication will go to the targeted area accurately as well as
to ensure patient safety. When optimal contrast flow is obtained, the medication
is injected. The medication consists of a corticosteroid and small amount of saline
solution or local anesthetic.
The procedure including preparation time on average requires 20-30 minutes. Afterwards,
a small Band-Aid is placed over the injection site, post-procedure instructions are
given, and then the patient is monitored for 5-10 minutes before going home.
What is expected after the injection?
Typically the injection site will be numb for 1-2 hours. After that, the injection
site is usually sore. Intermittent application of an ice pack to area is recommended
if the area is sore. A temporary mild increase in a patient’s symptoms may occur
until the effect of the corticosteroid takes place (usually within 2-3 days). The
corticosteroid will reduce the inflammation causing the patient’s pain. The goal
of the epidural steroid injection is to eliminate or significantly reduce the patient’s
How long will the injections last?
Although the effect of the corticosteroid is typically only a few weeks, the patient
may have pain relief for much longer. If the inflammation causing the patient’s
pain is significantly reduced, the pain may not come back.