What to Expect with Procedures


Epidural Steroid Injections


Epidural Steroid Injections (ESI) can help the pain you experience in your lower back, mid-back and neck area, making it easier for you to exercise and participate in physical therapy sessions. These injections tend to be very helpful with what is known as radicular (pain in the arms or legs) symptoms or “nerve pinching”. These can be done in three different areas of your spine:


  • Lumbar epidural steroid injection. This is used for the treatment of low back pain, such as spinal stenosis, sciatica, radiculopathy, herniated discs, degenerative disk disease etc.
  • Thoracic epidural steroid injection. This is used to treat the same problems mentioned above, but in the thoracic area.
  • Cervical epidural steroid injection. This is the same procedure mentioned above but done in the cervical region.

There are two different types of Epidural Steroid Injections, one is called interlaminar or translaminar, and the other one is the transforaminal. Both are very successful in the treatment of the above-mentioned problems.

Will the ESI cure my pain?

No, the procedure will help to lessen your pain, making it easier for you to participate in physical therapy to help improve your condition. How much relief and for how long varies among patients, depending on other medical conditions, the source of your pain, how long you've been having this problem, etc.

Are there any side effects or complications?

Yes, ESI is very safe, but as with any other medical procedure it has risks. The most common complication is a headache; this happens in 1 in every 100-200 cases. Other more serious complications, such as infection, allergic reaction, nerve damage, bleeding and paralysis, are extremely rare.

The steroid can cause some fluid retention, facial flushing, and may raise your blood pressure and blood sugar in diabetic patients. Talk to your physician about how to manage these side effects.

How is an ESI done?

First the skin will be cleaned with a special solution. This will feel cold. Then your skin will be numbed with a local anesthetic. This will induce a stinging and burning sensation for a few seconds.

During the Epidural Steroid Injection, a small needle is placed and advanced into the epidural space. Since the skin is numb from the local anesthesia, you might feel mild discomfort or pressure.

The time required to do the procedure varies from patient to patient, but it will usually take 10-15 minutes.

When can I go back to my normal activities?

As soon as possible. The staff in the clinic will provide you with care instructions after the injection. Please follow them. We prefer you to go back to your normal activities as soon as the next day. It is very important to keep your body active.

Is it safe?

Yes, but as mentioned before complications might occur, as well as side effects from the steroids.

Will the ESI prevent me from having surgery?

The procedure is to lessen your pain, not to prevent surgery since pain may or may not be the reason for the surgery. But in some cases surgery may not be necessary if you respond well to the therapy. Talk to the doctor before the procedure if you have any doubts about this.

I had ESI before and it did not help. Should I do another one?

It will vary from patient to patient, but it some cases a second or even a third injection could be helpful. Talk your doctor about another injection.

What if the procedure does not help my pain?

There are other therapies that we can use to manage your pain. Using different methods to treat your pain is the most successful way to relieve your pain and improve your quality of life. Other strategies to treat your include exercise, relaxation, and changing negative behaviors and thought patterns can help you cope better with your pain.

Who should not have the injection?

  • If you are pregnant or breastfeeding.
  • If you have a severe allergic reaction to local anesthetics or steroids.
  • If you are taking a blood thinner, such as Warfarin (Coumadin), Enoxaparin (Lovenox), Clopidogrel (Plavix), etc; and your medical condition does not allow us to stop it a few days prior to the procedure.
  • If you develop a fever or any infection.

Contact our office if you experience:

  • A severe headache
  • A fever
  • Pain that is more severe than prior to the injection
  • Increased back pain or back stiffness

Go to the nearest Emergency Department or call 911 if you develop any new numbness, weakness, and/or paralysis in your arms or legs or lose control of your bladder or bowels.


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