Epidural steroid injections (ESI) are performed to place anti-inflammatory medication (steroid) and local anesthetic in the epidural space to target irritated nerves and relieve pain. They are most commonly performed for patients with spine pain and radiating pain into either the arms or legs. Injections are performed under X-ray guidance.

There are three different ways to perform an ESI and your physician will choose the route that offers the best chance of relieving your pain based on several factors. The three methods of ESI are described below:

  • Caudal ESI: the Caudal approach involves an injection at the base of the spine near the tailbone. An advantage of this approach is that it can be performed even if you have had major spine surgery.
  • Interlaminar ESI: the Interlaminar approach can be performed at all levels of the spine from the low-back to the neck. This approach may not be possible if you have had spine surgery in the injection area. An advantage of this approach is that medication may be delivered closer to the area of pain.
  • Transforaminal ESI: the Transforaminal approach involves placement of the needle into the area where your spinal nerve exits the spine. It can be done throughout the spine, but is done most frequently in the low-back. This approach can be used in areas of prior surgery, and may deliver medication most accurately to the area of nerve irritation.

How long does an ESI take?

ESIs of any approach usually take about 10 to 15 minutes. Your procedure may take slightly longer if your physician recommends an approach at two different levels of your spine.

How will I feel afterwards?

The main benefit from the steroid usually takes effect in 48-96 hours. Some patients feel improvement right away. There may be a temporary sensation of pressure at the site of injection in some cases.

How long will the relief last?

Relief from an ESI or series of ESIs is varies between one to six months, but on average nearly two months.