An ESI is the injection of a steroid medication mixed with saline into the epidural space in your spine (neck or back). The epidural space is located in the spine, just outside the sac containing your spinal fluid. The epidural space contains the nerve roots that can become irritated and inflamed from problems in your spine, causing you pain. The goal of an ESI is to provide pain relief by reducing the inflammation (swelling) of nerve roots (tissue) and to promote healing in the area. There is no way to predict if and how much relief you will obtain. An ESI will not correct the preexisting medical problem (e.g., herniated disc, spinal stenosis), but hopefully it will help decrease the amount of pain you are experiencing. Ideally, the end result will allow you to become more active again. The steroid we inject is called a "depot" steroid, slowly getting degraded by your body over approximately six months. It works locally, directly on the inflamed tissue. It is not unusual for someone to need more than one injection to get maximal, long-term relief. We usually perform the injections four to six weeks apart. You are limited to three ESIs per six-month period because the medication lasts that long and subsequent doses are cumulative. If the pain is significantly improved, no further injections are needed unless the pain returns. Please note: This procedure cannot be performed if you have an active infection (and are on antibiotics), flu, fever, extremely high blood pressure, or if you are on blood thinners (e.g., aspirin, Coumadin, Plavix, Pletal). Blood thinners must be stopped five to seven days prior to the procedure. For your safety, please inform us if any of these conditions exists.
All potential complications occur rarely, with the most frequent being a spinal headache. This headache usually occurs 24 hours after the procedure and lasts for a few days without treatment. Other risks include bleeding, infection, nerve injury and allergic reaction to the medication. Diabetics need to keep a close watch on their blood sugars, which can be affected by the steroid medication.
After checking in and signing a consent form, you will be taken to a procedure room. Please wear loose-fitting clothing. You may be asked to change into a hospital gown. Our nursing staff will position you either on your abdomen, sitting or lying on the side. If necessary, we will ask you to curl into a ball, making a "C" out of your spine. The area of injection is then cleaned with an iodine solution and draped, and then the doctor numbs the skin and underlying tissue with a local anesthetic injection. This will sting slightly for a few seconds. A needle is then advanced into the epidural space, at which point it is important that you hold still. A dye may be injected at this point to confirm correct needle position. Please let the doctor know if you have any allergies to dye. Most patients describe what they feel as a mild pressure sensation. The steroid/saline mixture will then be injected slowly, which may increase the pressure some. Your skin will then be cleaned and the procedure completed. Nine out of 10 patients report that it was less painful than they expected.
The steroid usually takes 48 hours to take effect. Some people actually have an increase in their pain level temporarily. Local soreness from the needle is also expected. You may take your usual pain medications for this. Using an ice pack at the site of injection may help, as well. There is a chance that the injection provides no relief. If so, let us know after about a week to allow the steroids sufficient time to work.
Following your procedure, you are not allowed to drive for the remainder of the day. An adult must be present to drive you home or to escort you on another form of transportation. This is for your own safety. In addition, do not go swimming or soak in a tub or Jacuzzi on the day of your procedure. Otherwise, you can do whatever you feel up to doing.
You should call us immediately at 781-744-5090 if you experience any of the following: