Common reasons for an ESI
- Sciatica or arm pain from a herniated or bulging disc
- Spinal stenosis causing leg pain with walking or standing
- Pinched nerve (radiculopathy) from other causes
Types of epidural injections
- Interlaminar — medicine is placed in the epidural space from the back, between two vertebrae.
- Transforaminal / selective nerve root — medicine is placed right where a specific nerve root exits the spine. This can also help identify which nerve is causing symptoms.
- Caudal — medicine is placed through a small opening near the tailbone.
What to expect
The injection is done as an outpatient procedure. The skin is numbed, and the physician uses X-ray guidance, often with a small amount of contrast dye, to guide the needle precisely. The injection itself usually takes only a few minutes. Some people feel relief from the numbing medicine right away; the steroid typically begins working over several days.
How long relief lasts varies widely. Because of limits on how much steroid is safe over time, your provider will discuss how often injections can be repeated and how they fit into a broader plan that may include physical therapy and exercise.
Preparing for your injection
- Tell us about every medication you take, especially blood thinners (for example warfarin, apixaban, clopidogrel, or daily aspirin). Do not stop a blood thinner on your own — we will coordinate with the doctor who prescribes it.
- Let us know if you have diabetes, an allergy to contrast dye, iodine, latex, or local anesthetics, or if you may be pregnant.
- If you will receive sedation, plan on having an adult drive you home.
- Call us if you develop a fever or infection before your procedure date.
Risks
All procedures carry some risk. Depending on the treatment, possible risks can include soreness or bruising where the needle was placed, bleeding, infection, a temporary rise in pain, allergic reaction to a medication, and, rarely, nerve injury. If a steroid is used, some people notice short-term flushing, trouble sleeping, or higher blood sugar. Your provider will go over the specific risks, benefits, and alternatives for your situation before you decide.
Exercises you can do at home
Staying active is an important part of most pain treatment plans. See our low back (lumbar) exercises and neck (cervical) exercises for gentle stretches and strengthening options in lying, seated, and standing positions. Please ask your provider before starting, especially after a procedure.
This page is for general education and is not a substitute for an evaluation by a medical professional. Results vary, and no treatment works for everyone. Your provider will discuss whether this option is appropriate for you, along with its benefits, risks, and alternatives. Insurance coverage varies by plan — please call to verify.