Epidural Steroid Injections (ESI) are corticosteroid injections into the epidural space of the spinal column used to decrease pain and inflammation. ESIs can be performed in the cervical, thoracic, and lumbar spine. These are often used to treat radicular pain which is pain that radiates from the spine down an irritated spinal nerve root. This can cause shooting pains from the low back into one or both legs, as well as from the neck into one or both arms, typically caused by a pinched nerve. There are several ways to perform ESIs including the transforaminal, interlaminar, and caudal approach.
ESIs are used to treat neck and back pain with radiation down the arms or legs usually caused by nerve irritation and inflammation. This commonly occurs due to herniated disks, spinal stenosis, and sciatica.
The patient is positioned lying face down with a pillow underneath the abdomen. The skin over the low back is sterilely prepared. The skin is then anesthetized. A thin needle is then advanced under X-ray guidance to the appropriate region by the exiting nerve root, or into the center of the epidural space in the middle of the low back or neck using a specialized syringe. A small volume of contrast solution is injected to prove that the medication will flow along the course of the nerve root and in the epidural space. The doctor then injects a solution that contains a long-lasting steroid and may also use a local anesthetic. The ESI is designed to reduce the inflammation and irritation and interrupt the pain signal transmission.