Epidural Steroid Injections (ESI)

What is Epidural Steroid Injection (ESI)?

Epidural steroid injections are a highly effective treatment for patients experiencing nerve root compression in the spine. This condition can result from various spine-related issues, including disc protrusion, degenerative disc disease, osteoarthritis, or other structural abnormalities.
When nerve roots are compressed, they can radiate pain in different body parts, such as the lower back, buttocks, legs, neck, shoulders, arms, or upper back. The location of the pain typically corresponds to the region of the spine affected—most commonly the lumbar (lower back) or cervical (neck) spine.

How are Epidural Steroid Administered?

• Transforaminal injections enable placement of the steroid at the site of the inflamed disc or nerve root • Interlaminar injections allow the medication to spread through a targeted area in the epidural space.

Conditions Treated

• Herniated Disc• Degenerative Disc Disease• Spinal Stenosis• Sciatica• Radiculopathy (Nerve Root Pain)• Facet Joint Arthritis• Cervical, Thoracic, and Lumbar Spine Pain• Chronic or Acute Neck or Back Pain• Spinal Nerve Irritation or Inflammation• Failed Back Surgery Syndrome (Post-Surgical Pain)• Spondylolisthesis (Slipped Vertebra)• Coccygodynia (Tailbone Pain)

Benefits of Epidural Steroid Injections

• Quick Onset of Relief: The local anesthetic in the injection provides immediate pain relief by temporarily numbing the affected nerves.• Pain & Inflammation Management: Steroid injections, can offer short-term relief (weeks to months) upfront by reducing pain and inflammation in the epidural space. These can also be repeatable per protocol depending on patient response to treatment and individual needs.• Fewer Side Effects: Compared to oral medications, epidural steroid injection(s) may result in fewer systemic side effects, as the anesthetic and corticosteroid are delivered directly to the affected area.• Combination with Other Treatments: Often, epidural steroid injection(s) are included in a broader treatment plan. For instance, pairing epidural steroid injection(s) with physical therapy, lifestyle changes, or neuromodulation can enhance long-term outcomes.• Facilitates Physical Therapy & Overall Function: By reducing pain, epidural steroid injections allow patients to participate more actively in physical therapy, enhancing recovery and improving mobility.• Non-Surgical Treatment: Minimally invasive, requiring no major surgery, and has a shorter recovery time than traditional surgery.• Low-risk: Low-risk option for managing spine-related pain without surgery.• Long-Term Healing: Staging with PRP and/or stem cells at a later time, can address the underlying cause of the pain by promoting regeneration. The healing process can provide long-term benefits, reducing the need for repeated injections or invasive surgeries.

How does the Treatment Work?

• The procedure is performed in a medical office and typically takes 30 minutes to an hour, including pre and post-procedure monitorization.• The skin over the injection site is cleaned and sterilized to prevent infection.• A local anesthetic is applied to numb the skin and tissues around the injection site, reducing discomfort during the procedure.• Under guided fluoroscopy imaging (Real-time X-ray), the physician guides a needle through the numbed tissue and into the epidural space. Contrast dye is injected into the epidural space to confirm the needle’s placement. • Once the needle is positioned and placement is confirmed, the physician injects anesthetic and corticosteroid for immediate pain relief and inflammation reduction.• It is possible for the physician to stage treatment, whereby anesthetic and corticosteroid mixture is used first within the treatment plan.• Depending on the specific treatment goals and patient needs, at a later date, stem cells or a combination of PRP (platelet-rich plasma) and stem cells may be utilized, promoting regeneration and overall healing.

What to Expect After Treatment?

• Mild Discomfort: You may experience soreness or tenderness at the injection site for a few days.• Temporary Pain Increase: Some patients report a temporary increase in pain or discomfort after the procedure, which should subside within a few hours to a day.• Swelling or Bruising: Mild swelling or bruising around the injection site may occur and generally resolves within a few days.• Ice and Pain Relief: You may use ice to manage any swelling or discomfort and take acetaminophen (Tylenol) for pain relief, but avoid NSAIDs (e.g., ibuprofen - more so with cellular therapy) for the first few weeks to support healing. • Gradual Pain Relief: If a steroid is included for injection, you may experience immediate pain relief. However, the full benefit may take time; it may take 1-2 days for the full effect of the steroid to kick in, with more significant and longer-lasting pain relief occurring within 3-7 days.• Gradual Improvement: If PRP and stem cell therapy is utilized, improvement in pain and mobility may take time, with noticeable progress occurring over 3-6 weeks. Full benefits are often felt within 3-6 months.• Activity: Avoid strenuous activity, heavy lifting, or vigorous exercise for the first 24-48 hours after corticosteroid injection. If PRP and stem cell therapy is utilized, avoid strenuous physical activity or heavy lifting for 1-2 weeks to give your body time to heal and allow cellular therapy to begin working. Outside of this initial period, engaging in physical therapy or modifying activity levels, can enhance the effectiveness of treatment and prolong pain relief.• Monitor Progress: Track changes in your pain levels and mobility to evaluate the effectiveness of the facet joint injection(s).• Follow-up: Your healthcare provider will schedule follow-up to assess how well the injections are working and determine next steps.