This video explains the steps of an ESI, showing how it relieves nerve-related pain.

Epidural Steroid Injection (ESI)

Epidural Steroid Injections are minimally invasive procedures designed to relieve pain caused by nerve inflammation in the spine. These injections deliver anti-inflammatory medication directly to the source of pain, helping patients with conditions such as herniated discs, sciatica, and spinal stenosis.

What does an ESI treat?

  • Herniated Disc

  • Sciatica

  • Spinal Stenosis

  • Degenerative Disc Disease

Procedure Steps

  1. Preparation: Local anesthetic numbs the area.

  2. Needle Guidance: X-ray guides the needle to the nerve.

  3. Injection: Contrast dye confirms placement, followed by steroid injection.

  4. Recovery: Most patients resume normal activities within 24 hours

Benefits of ESI

  • Targeted Pain Relief: Directly addresses the inflamed nerve.

  • Minimally Invasive: No surgery needed.

  • Quick Recovery: Return to routine activities within a day.

Preparation & Post-Care

  • Before: Stop certain medications as directed by your provider, fast for 3 hours, and arrange a driver if sedated.

  • After: Avoid vigorous activities and submerging the injection site for 24 hours. Relief is commonly reported within 7 days.

  • Interlaminar epidural steroid injections (IESI) treat a broader area, while transforaminal epidural steroid injections (TFESI) target specific nerve roots.

  • The injection itself takes about 15-30 minutes.

  • Discontinue the following medications:

    • Lovenox (enoxaparin) 12-24 hours prior to procedure

    • Integrilin (eptifibatide) 1 day prior to procedure

    • Aggrastat (tirofiban) 1 day prior to procedure

    • Pletal (cilostazol) 2 days prior to procedure

    • Trental (pentoxifylline) 2 days prior to procedure

    • Eliquis (apixaban) 3 days prior to procedure

    • Savaysa (edoxaban) 3 days prior to procedure

    • Xarelto (rivaroxaban) 3 days prior to procedure

    • Pradaxa (dabigatran) 3 days prior to procedure

    • Arixtra (fondaparinux) 4 days prior to procedure

    • Aspirin 5 days prior to procedure

    • Warfarin (coumadin) 5 days prior to procedure

    • Reopro (abciximab) 5 days prior to procedure

    • Brilinta (ticagrelor) 5 days prior to procedure

    • Aggrenox (dipyridamole) 7 days prior to procedure

    • Plavix (clopidogrel) 7 days prior to procedure

    • Effient (prasugrel) 7 days prior to procedure

    • Ticlid (ticlopidine) 14 days prior to procedure

  • What should I do before the procedure?

    • Medication: Stop blood thinners and specific medications as directed by your provider.

    • Fasting: Avoid eating for 3 hours before the procedure; clear liquids are allowed up to 1 hour before.

    • Allergies: Inform your doctor if you’re allergic to latex, adhesives, anesthetics, steroids, or contrast dye.

    • Arrange Transport: If sedation is used, plan for someone to drive you home.

  • Avoid submerging the injection site in water for 24 hours and limit vigorous activities.

  • Conscious sedation is offered at a self pay rate of $250 to help you feel more relaxed. Undergoing conscious sedation will require that you have a driver.