What Is an Epidural Steroid Injection?
An epidural steroid injection (ESI) is a minimally invasive procedure in which a corticosteroid (and often a local anesthetic) is delivered into the epidural space surrounding the spinal nerves. The goal is to reduce inflammation and relieve pain that radiates from the spine into the arms or legs (radicular pain).
The injection is almost always performed with fluoroscopic (live X-ray) guidance so the physician can place the medication accurately. Common approaches include interlaminar, transforaminal, and caudal.
Why Might I Need an Epidural Injection?
Your doctor may recommend an epidural steroid injection if you have:
- Radicular pain (pain that radiates into an arm or leg), often from a herniated disc, spinal stenosis, or nerve root irritation
- Sciatica or cervical radiculopathy that has not improved adequately with medication, physical therapy, or other conservative care
- Inflammation around spinal nerves that is contributing to pain
- A need for temporary pain relief to allow better participation in physical therapy or daily activities
Relief from an epidural injection can last from weeks to several months. Results vary from person to person.
How Do I Prepare?
Typical preparation includes:
- Medications: Tell your doctor about all medications, especially blood thinners. Certain blood thinners may need to be stopped for a short period (only as directed by your physician).
- Eating & drinking: Most patients can eat and drink normally unless sedation is planned.
- Clothing: Wear comfortable clothing that allows easy access to the back or neck.
- Allergies: Inform the team of any allergies to local anesthetics, steroids, or contrast dye.
- Transportation: Arrange for someone to drive you home if sedation is used or if you prefer not to drive afterward.
How Is the Procedure Performed?
The procedure is performed in an outpatient setting and usually takes 15–30 minutes.
Typical steps:
- You lie face-down (or on your side) on the procedure table. The skin is cleaned with an antiseptic solution.
- Local anesthetic is used to numb the skin.
- Using live X-ray (fluoroscopy) guidance, a thin needle is carefully advanced into the epidural space.
- A small amount of contrast dye is often injected to confirm correct needle position.
- The corticosteroid and local anesthetic mixture is injected into the epidural space.
- The needle is removed and a small bandage is applied.
What Should I Do for Aftercare?
Immediate Care
- You will be monitored briefly after the procedure.
- You can usually go home the same day.
- The local anesthetic may provide rapid, temporary relief that lasts a few hours.
Activity Guidelines
- Rest and avoid strenuous activity, heavy lifting, or prolonged sitting for the remainder of the day.
- Gradually return to normal activities as comfort allows over the next 1–2 days.
- The steroid typically begins working within 2–7 days (sometimes longer). Maximum benefit may take up to two weeks.
What to Expect
- A temporary increase in pain is possible for a day or two after the injection.
- Some patients notice improvement within a few days; others may need more than one injection over time.
What Are the Risks?
Epidural steroid injections are generally safe when performed with image guidance by experienced physicians. Possible risks include:
- Temporary increase in pain or soreness at the injection site
- Infection or bleeding (rare)
- Allergic reaction to the medication or contrast
- Temporary numbness, weakness, or headache
- Incomplete or short-lived pain relief
Your physician will discuss the specific risks and benefits for your situation.
When Should I Call My Doctor?
Contact your healthcare provider if you experience:
- Increasing redness, swelling, warmth, or drainage from the injection site
- Fever
- Severe or worsening pain
- New or prolonged numbness, weakness, or difficulty moving
- Severe headache, especially one that worsens when sitting or standing
