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Epidural Steroid Injection

What is an epidural steroid injection or ESI?

ESI has been used to treat low back and radicular pain (sciatica). ESI has been shown to be effective in treatment of radicular symptoms due to disc herniation, central spinal stenosis, and neuroforaminal stenosis. Limited evidence supports the role of ESI for axial pain. ESI is a reasonable nonsurgical option in select patients.

How is an ESI performed?

Aspirin-based products and platelet inhibitors are discontinued 7 to 10 days prior to injection. The setting for ESI injection is a hospital operating room. Injection will be performed under fluoroscopic guidance and with use of a contrast dye in order to deliver medication as close to the disc herniation, area of stenosis, or nerve root impingement, as determined by MRI. A mixture of local anesthetic and corticosteroid is injected into the epidural space via various approaches: interlaminar, transforaminal, or caudal. The choice of injection technique is based on several factors. Procedure time is about 10-20 minutes. After the procedure, the patient will be observed in the recovery room for 30 minutes. For your safety, the patient needs to transport by accompany from the hospital to home. With some patients, steroids require a couple days to be effective. 

What are the indications for ESI?

1. Low back pain associated with radicular symptoms

2. Axial pain subgroups, such as those with annular tears or disc end-plate inflammatory changes

3. Failure of medications, therapy, and rest, with persistence of functionally limiting back and leg pain beyond 6 weeks

What are the contraindications for ESI?

        -    Local infection at the injection site

        -    Systemic infection

        -    Bleeding diathesis

        -    Uncontrolled diabetes mellitus

        -    Uncontrolled cardiovascular disease

        -    Allergy to medications                                                                               

        -    Pregnancy 

        -    Coagulopathy    

What are the benefits and risks of ESI?

Benefits of ESI: 

        -    To relieve pain and to increase the quality of life

        -    Allowing participation in recreation activities

        -    Less invasive, with short recovery time 

Performed as outpatient clinic:

The patients who received ESI showed significant improvement in function at 6 days and showed significant improvement in pain at both 30 days and 6 months. If the initial response to ESI is favorable but short-lived, a series of injections (3-6 times per year) is recommended. The interval for sequential block varies from days to weeks for a series of injections.

Risks of ESI:

        -    Postinjection exacerbation of pain (1% of cases) 

        -    Increase in blood glucose level from steroid injection

        -    Neurologic complications due to direct nerve trauma 

        -    The procedure may need to be repeated in 3-6 months

        -    Infection (very rare)

        -    Bleeding (very rare)


Dr.Chaiyot Chaichankul

Orthopedic Sugeon-Spine Specialist


You may find our specialist at Orthopedic Institute, Phyathai 2 Hospital

Phyathai 2 Hospital

International Correspondence Center

Tel:  +66-2617-2444 ext. 2020 or 2047 E mail: