ESI; Spinal injection for back pain; Back pain injection; Steroid injection - epidural; Steroid injection - back
An epidural steroid injection (ESI) is the delivery of powerful anti-inflammatory medicine directly into the space outside of the sac of fluid around your spinal cord. This area is called the epidural space.
ESI is not the same as epidural anesthesia given just before childbirth or certain types of surgery.
ESI is done in a hospital or outpatient clinic. The procedure is done in the following way:
Your doctor may recommend ESI if you have pain that spreads from the lower spine to the hips or down the leg. This pain is caused by pressure on a nerve as it leaves the spine, most often due to a bulging disc.
ESI is used only when your pain has not improved with medicines, physical therapy, or other nonsurgical treatments.
ESI is generally safe. Complications may include:
Talk to your doctor about your risk of complications.
Having these injections too often may weaken the bones of your spine or nearby muscles. Receiving higher doses of the steroids in the injections may also cause these problems. Because of this, most doctors limit patients to two or three injections per year.
Your doctor will most likely have ordered an MRI scan of the back before this procedure. This helps your doctor determine the area to be treated.
Tell your doctor or nurse:
You may be told to stop taking medicines that make it hard for your blood to clot for several days before the test. This may include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), naproxen (Aleve, Naprosyn), and heparin.
You may feel some discomfort in the area where the needle was inserted. This should last only a few hours.
You may be told to rest for the rest of the day.
Your pain may become worse for 2 to 3 days after the injection before it begins to improve. The steroid usually takes 2 to 3 days to work.
If you receive medicines to make you sleepy during the procedure, you must arrange for someone to drive you home.
ESI provides short-term pain relief in at least half of the people who receive it. Symptoms may remain better for weeks to months, but rarely up to a year.
The procedure does not cure the cause of your back pain. You will need to continue back exercises and other treatments.
Chou R, Loeser JD, Owens DK, Rosenquist RW, et al. American Pain Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine. 2009;34(10):1066-77. PMID: 19363457
Dixit R. Low back pain. In: Firestein GS, Budd RC, Gabriel SE, et al, eds. Kelly's Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 47.
Henwood AM, Benzel EC. Nonoperative management of neck and back pain. In: Benzel EC, ed. Spine Surgery. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 189.
Last reviewed on: 5/13/2015
Reviewed by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.