Epidural Steroid Injection (ESI)

What is an epidural steroid injection and how is it performed?

An epidural steroid injection is a non-surgical treatment used for temporary pain relief in the arm, leg, lower back and neck. Pain is caused by an irritation of the spinal nerves and an epidural steroid injection can relieve the symptoms for a period of one week up to one year. A medication containing a mixture of local anesthetic and steroid medication is injected into the epidural space of the spine, which is located between the bony vertebra and dura mater, a tough and inflexible membrane that surrounds the spinal cord and nerve roots, and contains cerebrospinal fluid.

An epidural steroid injection is performed with the patient lying on his or her abdomen and the area of the skin where the needle will be injected is numbed with a local anesthetic. Fluoroscopy (live x-ray) is used to aid the neuroradiologist in guiding the needle directly into the epidural space. Once the needle has reached the epidural space, a small amount of contrast dye is injected into the area to ensure proper needle placement followed by the steroid. The needle is then removed.

Before the Procedure:

Once scheduled for a nerve root block, you will be contacted by one of the spine nurses. You will be asked to provide information regarding your current problem, past medical history, and medications. You must bring your most recent MRI with you. The nurse will provide you with detailed instructions on how to prepare for the upcoming procedure. You will be asked to hold any blood thinning medications such as Coumadin, Plavix, Aspirin, and any NSAIDS. Any insurance questions can be answered by your referring physician.

The Day of the Procedure:

Prior to arrival, we ask that you eat a light breakfast. Please hold any pain medications that morning but bring them with you, you can take them after the procedure. We do not dispense or provide prescriptions for medications. You will need someone to drive you home. Patients without a driver will be rescheduled for another day.

Following registration, the spine nurse will escort you to the spine assessment room where you will be asked to change into a hospital gown. Vitals signs will be taken, a pain assessment note evaluating your pain symptoms will be written, and questions regarding the procedure will be reviewed. You will then be taken to the procedure room.

Once the procedure is completed you will be escorted back to the spine assessment room where you may get dressed. Discharge instructions will be provided by the nurse.

Following the injection, you may have temporary numbness or weakness of your extremities lasting up to 6 hours. Sometimes it may be difficult to walk due to a lack of sensation in your foot. As this subsides, some patients report increased discomfort. This can be related to irritation from the steroid and will resolve. You should begin to notice pain relief after 3-7 days. We cannot predict or guarantee how much pain relief you will receive. The expected success rate depends on your diagnosis.

How soon can I return to my normal activities following an epidural steroid injection?

Upon discharge, you will be asked to rest for 24 hours and refrain from driving or operating machinery for 24 hours. We can provide a total of three injections within a six-month time period. Injections must be spaced a minimum of two weeks apart and you must contact your doctor in between injections to receive a new prescription for each.

Is an epidural steroid injection covered by insurance?

You should direct any insurance questions to your referring physician and/or insurance provider.