ESI (Epidural Steroid Injection)
Epidural steroid injections, or ESIs, are used to temporarily relieve lumbar (lower back) pain and sciatica. They have also been shown to be effective for cervical (neck) and thoracic (midspine) pain. While ESIs do not treat underlying spinal conditions, they are often effective in relieving the chronic pain these conditions may cause. Comprised of cortisone and a local anesthetic, ESIs work by reducing inflammation.
Because it is administered as an injection rather than orally, medication is delivered directly to the epidural space, the area between the spinal cord and the outer membrane that covers the brain and spinal cord (the dura), providing more effective pain relief more quickly.
Candidates for Epidural Steroid Injections
Epidural steroid injections can be used to relieve pain not only in the back, but also pain radiating down the arms and legs. Pain relieved by epidural steroid injections may be the result of many conditions, including:
- Lumbar disc herniation
- Degenerative disc disease
- Lumbar spinal stenosis
- Vertebral compression fractures
- Cysts in a facet joint or nerve root
- Annular tear
Epidural steroid injections can be used alone to provide pain relief or given as part of a rehabilitation program to help a patient perform physical therapy exercises with less discomfort. Relief from a single injection may last from 1 week up to 1 year; a typical positive response may last for 1 month. If helpful, these injections may be repeated at 2-week intervals, but usually no more than 3 or 4 times per year. ESIs can also be of diagnostic value in pinpointing the source of the pain and determining its severity, which can assist the physician in developing an appropriate treatment plan.
The Epidural Steroid Injection Procedure
Epidural steroid injections can be administered by many types of physicians, including anesthesiologists, orthopedists, physiatrists, pain management specialists and neurologists. Typically they are administered in an outpatient facility under the guidance of fluoroscopy to verify that the medication is reaching the inflamed nerve root. Because the injection contains a local anesthetic as well as a corticosteroid, the injection is not usually painful, although the patient may feel pressure at the injection site. The injection procedure takes only a few minutes.
In most cases, the patient experiences immediate pain relief due to the anesthetic, but this relief is temporary and will wear off in a few hours. During the next day or two, however, as the corticosteroid works to reduce inflammation in the area, the patient should feel a significant, if not total, alleviation of pain. Normally, the patient can resume normal activities the day following the procedure.
Risks of Epidural Steroid Injections
For most patients, epidural steroid injections are a very safe form of treatment. As with all medical procedures, however, there is a possibility of complications. In rare instances, patients who have received epidural steroid injections may experience headache, bleeding, infection, nausea or vomiting, allergic reaction or nerve damage. This treatment should not be administered to patients who are pregnant or have a bleeding disorder or infection. ESIs may temporarily elevate blood pressure and blood sugar and cause mood swings, so patients with hypertension, diabetes and mood disorders should be monitored with extreme care before, during and after treatment.
A lumbar laminectomy also relieves the pressure of a pinched nerve, but does so by removing a portion of the lamina, the bony rim around the spinal canal. This procedure is often used to treat spinal stenosis and disc degeneration. An X-ray is often used to ensure accuracy of this procedure.