Epidural Steroid Injections (ESI)
Epidural Steroid Injections (ESI)
Targeted image-guided delivery of anti-inflammatory medication into the epidural space to alleviate nerve root irritation, reduce discogenic pain, and restore functional mobility.
Download Patient Information Guide (PDF)Overview
Epidural steroid injections deliver a concentrated corticosteroid — combined with local anaesthetic — directly into the epidural space surrounding the spinal nerve roots. Unlike oral anti-inflammatory medications that must circulate through the entire body before reaching the target, this targeted approach achieves high local anti-inflammatory efficacy while minimising systemic exposure. All injections are performed under real-time fluoroscopic (X-ray) guidance with contrast confirmation to ensure precise, safe needle placement.
Approaches & Techniques
Transforaminal (TFESI): A focused single-level approach that targets the nerve root sleeve directly at the intervertebral foramen. Ideal for unilateral sciatica, cervical radiculopathy, and arm pain from a specific disc level.
Interlaminar (ILESI): A central approach between adjacent vertebral laminae, allowing medication to spread across multiple levels. Preferred for bilateral or multi-level disc disease, central stenosis, and diffuse symptoms.
Caudal: Performed via the sacral hiatus at the base of the spine. Particularly suited to lower lumbosacral pain, post-surgical epidural fibrosis, or patients with spinal fusion hardware that limits other approaches.
Clinical Benefits
Corticosteroids begin reducing nerve root inflammation within days, providing a meaningful "rehabilitation window" during which patients can actively engage in physiotherapy and functional restoration with reduced discomfort. For many patients, a successful ESI can defer or avoid the need for surgical intervention, while also reducing reliance on oral pain medications.
Potential Risks & Complications
Common / transient: Local tenderness at the injection site, temporary numbness or heaviness from local anaesthetic, a transient steroid flush (facial warmth or flushing), and a brief elevation in blood sugar levels in patients with diabetes.
Rare: Dural puncture headache, vasovagal episodes, infection, or epidural haematoma. These risks are minimised through live fluoroscopic guidance, contrast verification of needle position, and the use of non-particulate corticosteroids for transforaminal approaches.
Aftercare & Recovery
- Do not drive on the day of the procedure — arrange a responsible adult to take you home.
- Rest for 24 hours following the injection; light activity may resume the next day.
- Keep the dressing clean and dry for 48 hours — avoid baths, swimming, or soaking the area.
- Maintain a symptom diary in the days following the procedure to help your specialist assess the response.
- Seek urgent review if you experience severe headache, fever, increasing back pain, or any new weakness or numbness in the legs.
Conditions Treated
- Lumbar Radiculopathy (Sciatica)
- Cervical Radiculopathy (Nerve-related arm pain)
- Lumbar & Cervical Disc Herniations
- Spinal Canal & Foraminal Stenosis
- Post-Laminectomy Syndrome / Persistent Post-Surgical Spine Pain
- Spondylolisthesis with nerve irritation
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Our specialist team can assess whether an epidural steroid injection is appropriate for your condition.
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