Epidural Spine Injection (ESI)

What is it?

An epidural spine injection (ESI) places strong anti-inflammatory medication into the epidural space. The epidural space is to the exterior of the sac fluid that surrounds the spinal cord. The anti-inflammatory is injected with a needle into the back.

What is it for?

ESIs are conducted for low back pain that extends from the lower spine to the hips and legs. The pain can be caused by excessive nerve pressure from a bulging disc. ESIs are usually done when the back pain is not helped by medications, physical therapy and other nonsurgical treatments.

How to prepare

  • You may need some preliminary tests prior to the procedure such as an MRI scan of your back
  • Tell your doctor about your health history, medications you are taking and any allergies
  • You will need someone to drive you home following the procedure
  • Do not eat or drink anything several hours before the epidural


  • You may need to stop certain medications
  • Headache
  • Bleeding (rare)
  • Infection (rare)

What happens during?

  • You may be given medicine to make you feel relaxed and sleepy
  • You will lie on your belly on a table
  • Your skin will be cleaned in the area of the injection
  • With a needle, the health care provider will inject an anesthetic in your back for numbing
  • The provider will use an X-ray or CT scan to find the exact area of your epidural space. They will use dye as a contrast material to determine the precise injection point.
  • The medicine, which includes an anesthetic for numbing and an anti-inflammatory for pain and nerve irritation, is injected into the epidural space. You may feel some discomfort and pressure.
  • The needle is removed and a bandage may be placed over the injection site

What happens after?

  • You will be monitored by health care staff. You should be able to go home in about an hour.
  • You should rest for the remainder of the day but you should be able to resume normal activities the following day
  • Your pain does not go away immediately. It may take a few days to a week for the pain to begin to go away.
  • You may experience some arm numbness

Side effects

Call your health care provider immediately if you are at home and have:

  • A fever of 100°F or higher
  • Numbness at the injection site that does not go away
  • Continued redness discoloration and warmth at the injection site
  • Pain that is getting worse

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