An epidural steroid injection (ESI) is a minimally invasive procedure that is used to treat chronic pain in the neck, mid back, or low back. This pain is caused by an irritated, injured or compressed nerve root. More specifically ESI is used to treat radicular pain, which is pain that starts in the spine and radiates down a spinal nerve.

Epidural steroid injections work by delivering medication (typically a combination of local anesthetic and a steroid) as close to the pain site as possible in order to reduce inflammation. They are often used to reduce inflammation caused by a variety of spinal conditions, including degenerative disc disease, spinal stenosis, sciatica and herniated disc.

ESI treatment may provide rapid pain relief, allowing patients to resume their normal activities and start physical therapy or other treatment. It may also be used to determine whether surgery may provide pain relief for patients with a herniated disc.



Cervical radiculopathy – nerve irritation in the cervical spine (neck) causes the pain to travel down an arm. 

Thoracic Radiculopathy – when nerve irritation in the thoracic spine (mid back) causes the pain to travel into the ribs or abdomen. 

Lumbar Radiculopathy – when nerve irritation in the lumbar spine (lower back) causes pain to travel into the groin or down a leg.



The procedure is performed with the patient lying face down. Before the epidural injection is administered, the patient will receive a local anesthetic to numb the skin around the area for injection. The doctor will then insert the needle, using fluoroscopy (real-time X-ray) to guide it into the epidural space. Contrast dye may be injected to confirm that the needle is in the right place. Once the needle is placed in the desired area, the medication will be injected. The injection will include a steroid to reduce inflammation and may also include an anesthetic to provide pain relief.

There are three types of epidural injections: transforaminal, intralaminar, and caudal. There are a few small differences between these ESIs, but the main difference is where the epidural needle must be inserted. 

The type of injection a patient will get depends on the condition and the source of pain. After reviewing your medical history and performing a physical exam, your pain specialist will decide which ESI procedure will give you the best results.



Many patients experience pain relief after an ESI, typically within three days to one week. The amount of pain relief and how long it lasts will vary. If your pain improves moderately, the doctor may recommend one or two more injections to achieve more long-term results. The injections may be given as part of a comprehensive care plan that includes other treatments, such as physical therapy or medication.

If the epidural steroid injection does not lessen the pain at all, than the patient will most likely not benefit from further ESI treatments. The pain specialist will discuss other treatment options to help manage the pain.