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Epidural Steroid Injection (ESI)

What Is an Epidural Steroid Injection?

An epidural steroid injection delivers anti-inflammatory medication to the area right next to the spinal nerves that are causing your pain. If a nerve in your spine is being pinched or irritated — by a bulging disc, bone spur, or narrowing of the spinal canal — it becomes inflamed and swollen. That inflammation is what causes the sharp, shooting, or burning pain that can radiate down your arm or leg.

An ESI calms that inflammation down, giving the nerve a chance to heal and giving you relief from pain.

If you've heard the word “epidural” before, you might be thinking of the one given during childbirth. It's a similar concept — medication is placed near the spinal nerves — but the goal here is to reduce inflammation and pain, not to numb you for delivery.

Two Approaches — Same Goal

There are two ways Dr. Patibanda may perform your epidural injection:

  • Interlaminar approach — the medication is delivered into the epidural space from the back of the spine, spreading to cover a broader area
  • Transforaminal approach — the medication is directed to a specific nerve root through the opening where the nerve exits the spine, targeting the exact source of your pain

Dr. Patibanda will choose the approach that's best for your specific condition. Both are safe, effective, and performed with image guidance for precision.

What Does an ESI Treat?

Epidural steroid injections are one of the most well-studied and effective treatments for nerve-related spine pain, including:

  • Herniated or bulging discs — when disc material presses on a nerve
  • Sciatica — that sharp pain, tingling, or numbness that shoots down your leg
  • Spinal stenosis — narrowing of the spinal canal that crowds the nerves
  • Radiculopathy — a pinched nerve in the spine causing pain, numbness, or weakness in your arms or legs
  • Degenerative disc disease — wear-and-tear changes in the spine that irritate nearby nerves

What Happens During the Procedure?

The procedure typically takes about 15–20 minutes. Here's the step-by-step:

  1. You'll be positioned comfortably — usually lying face down, sometimes slightly propped up
  2. The skin is cleaned with sterile solution
  3. A numbing shot is given to the skin and deeper tissue — a brief sting that quickly fades
  4. Dr. Patibanda uses fluoroscopy (live X-ray) to guide a thin needle to the precise location near the affected nerve
  5. Contrast dye is injected to confirm the medication will flow exactly where it needs to go
  6. The steroid and anesthetic are delivered — you may feel pressure or a brief reproduction of your usual pain as the medication reaches the inflamed nerve. This is actually a good sign — it means we're in the right spot
  7. The needle is removed, a bandage is applied, and you're moved to a recovery area for a short observation period

How to Prepare

  • Medications: Tell us about everything you take, especially blood thinners. Some may need to be paused — Dr. Patibanda will provide specific instructions
  • Eating: Eat normally unless you're told otherwise
  • Clothing: Wear loose, comfortable clothes. You may change into a gown
  • Transportation: Bring a driver. Your legs may feel temporarily heavy or numb afterward
  • Allergies: Let us know about any medication allergies, especially to contrast dye, steroids, or local anesthetics

Recovery and What to Expect

Day of the procedure

You may feel immediate relief from the local anesthetic — this wears off in a few hours. Your legs may feel heavy, warm, or slightly numb. This is temporary. Rest for the remainder of the day and ice the injection area if it's sore.

Days 1–3

Mild soreness at the injection site is normal. Your original pain may briefly return or feel slightly worse before the steroid takes full effect — don't be discouraged, this is common.

Days 3–7

The steroid starts reducing inflammation. Many patients begin noticing real improvement during this window.

Weeks 2–6

Peak benefit. This is when most patients feel the best results. Resume normal activities gradually — Dr. Patibanda may recommend physical therapy to strengthen the area while you're feeling better.

Long-term

Relief can last weeks to several months. Some patients get lasting relief from one or two injections. Others may need periodic injections as part of an ongoing management plan.

How Many Can You Get?

Dr. Patibanda typically recommends no more than 3 epidural steroid injections per year in the same area. This limit helps protect the surrounding tissue from the cumulative effects of steroids. If your pain returns frequently, other treatment options can be explored — including radiofrequency ablation, physical therapy, or other approaches.

Risks and Benefits

Benefits

  • • Targeted relief right at the source of your pain
  • • Can significantly reduce pain, numbness, and tingling
  • • Helps you participate in physical therapy
  • • May help you avoid or delay surgery
  • • Well-established procedure with decades of safety data

Risks (uncommon)

  • • Mild soreness or headache
  • • Temporary increase in blood sugar (important for diabetics)
  • • Temporary fluid retention or facial flushing
  • • Infection — very rare
  • • Nerve injury — extremely rare
  • • Dural puncture headache — uncommon and treatable

When to Call Our Office

Contact us right away if you experience:

  • Severe headache that gets worse when you sit or stand up (and improves when you lie flat)
  • Fever or chills
  • Increasing pain that worsens significantly after the first 2–3 days
  • New or worsening weakness or numbness in your legs
  • Difficulty with bladder or bowel control (rare — go to the ER immediately)
  • Redness, swelling, or drainage at the injection site

Frequently Asked Questions

How quickly will I feel relief?

You may feel some immediate relief from the numbing medication, but the real improvement comes from the steroid, which typically takes 3–7 days to fully kick in.

Can I drive myself home?

No. The injection can temporarily affect sensation and strength in your legs. Please arrange for someone to drive you. You can usually drive the following day.

How long does the relief last?

It varies. Some patients get weeks of relief, others get months. The goal is to reduce inflammation enough for healing to occur and for you to engage in physical therapy.

Will the injection hurt?

Most patients feel a brief sting from the numbing shot and some pressure during the procedure. Many patients tell us it was much easier than they expected.

What if it doesn't work?

Not every injection provides relief, and that's okay — it still gives us valuable information about your pain. Dr. Patibanda will discuss alternative approaches if the first injection doesn't provide adequate improvement.

Is an epidural injection the same as back surgery?

Not at all. An ESI is a minimally invasive procedure done with a needle — no incisions, no anesthesia, no hospital stay. Many patients get enough relief to avoid surgery entirely.

Still have questions? We understand — this is your body, and you deserve to feel informed and comfortable. Call our office anytime.