What Is an Epidural Steroid Injection?

• In simple terms: A steroid and anesthetic mixture is injected near the irritated spinal nerves to calm inflammation and relieve pain.
  
  

• Scientifically: ESI involves percutaneous placement of a spinal needle into the epidural space (interlaminar, transforaminal, or caudal) under fluoroscopy, with injection of corticosteroid and anesthetic to suppress pro-inflammatory mediators and improve radicular pain.
  
  

Conditions Treated

• Herniated discs causing sciatica or arm pain
  
  

• Spinal stenosis
  
  

• Radiculopathy (pinched nerve symptoms)
  
  

• Sciatica
  
  

• Recurrent nerve inflammation after back surgery
  
  

• Chronic pain not responding to conservative care
  
  

Types of Epidural Steroid Injections

1. Interlaminar ESI

• Needle placed between vertebrae into posterior epidural space.
  
  

• Medication spreads to multiple levels.
  
  

2. Transforaminal ESI

• Needle directed into the foramen (nerve root exit).
  
  

• Highly targeted—ideal for pinched nerve at a single level.
  
  

3. Caudal ESI

• Needle inserted into epidural space through sacral opening.
  
  

• Useful when multiple levels or prior surgeries limit access.
  
  

The ESI Procedure: Step by Step

Plain-English Overview

1. Preparation: Outpatient procedure; local anesthesia with mild sedation if needed.
   
   

2. Needle placement: Guided into epidural space using live X-ray.
   
   

3. Contrast dye: Confirms correct needle location.
   
   

4. Steroid injection: Medication delivered around irritated nerves.
   
   

5. Observation: Short recovery; home same day.
   
   

Surgeon-Level Detail

• Positioning: Patient prone; sterile prep and draping.
  
  

• Needle placement: 22G spinal needle advanced under AP/lateral fluoroscopy.
  
  

• Contrast injection: Non-ionic contrast injected to confirm epidural spread; no intrathecal or intravascular uptake.
  
  

• Medication: Mixture of corticosteroid (e.g., triamcinolone, dexamethasone) and anesthetic injected slowly.
  
  

• Closure: Needle removed; sterile dressing applied; patient monitored briefly.
  
  

Benefits of Epidural Steroid Injections

• Targeted delivery of medication
  
  

• Relief from nerve pain, sciatica, and inflammation
  
  

• Outpatient procedure with minimal downtime
  
  

• Can delay or avoid major surgery
  
  

• Helps confirm diagnosis by identifying pain source
  
  

Risks & Limitations

• Temporary soreness or headache
  
  

• Infection, bleeding, or nerve injury (rare)
  
  

• Relief may be temporary—weeks to months
  
  

• Not a cure for structural instability
  
  

• Multiple injections may be needed for lasting benefit
  
  

Recovery Timeline

• Day 0: Mild soreness possible; most resume light activity same day
  
  

• Days 1–3: Pain relief may begin; steroid effect builds gradually
  
  

• Weeks 1–2: Maximum benefit usually seen
  
  

• Months: Relief may last weeks to months; repeat injections may be recommended
  
  

Why Choose Desert Spine and Pain?

• Neurosurgeon-led expertise: Dr. Greenwald ensures precise placement under fluoroscopy
  
  

• Safe and effective: Real-time imaging minimizes risk and maximizes accuracy
  
  

• Patient-first philosophy: We explain every step to reduce anxiety and build confidence
  
  

• Comprehensive approach: Injections used alongside PT, medications, or surgery as needed
  
  

Frequently Asked Questions

How long do epidural injections last?

Relief may last from a few weeks to several months, depending on condition and severity.

How many injections can I have?

Most patients receive up to 3 per year, spaced out for safety.

Are epidural injections painful?

Mild pressure may be felt, but most patients tolerate the procedure well.

Do epidural injections replace surgery?

Sometimes. For many patients, injections provide enough relief to delay or avoid surgery, but if compression is severe, surgery may still be needed.

How does Desert Spine and Pain perform ESIs differently?

We use fluoroscopy, neurosurgical precision, and patient-tailored dosing, ensuring maximum relief with the highest safety standards.