ESIs work by injecting steroids into the epidural space—the area surrounding the spinal cord. Steroids are anti-inflammatory medications that help reduce inflammation when injected in the nerves, nerve roots, disc spaces, and connective tissue. By decreasing inflammation, ESIs relieve pain, numbness, and tingling, allowing the nerves to function more effectively.

If you are taking blood thinners, it's important to consult with the facility to determine how long you should discontinue the medication before the procedure. Depending on the blood thinner, blood tests may be necessary to ensure that your blood is not too thin for the procedure.

The injection itself typically takes 5-10 minutes, and the recovery time ranges from 10-30 minutes.

After the injection, you will be asked to relax on a cart for 10-30 minutes. If you received an injection in the caudal or lumbar region, you may experience temporary numbness in your legs due to the anesthetic. This sensation should subside within 1-6 hours as the anesthetic wears off.

It’s important to refrain from strenuous activity or heavy lifting for 24 hours following the injection. You should also avoid driving or operating machinery on the day of your procedure to allow the steroid to remain in place and work effectively.

You will be asked to decrease your activity for 24 hours (no strenuous activity or heavy lifting). On the day of your injection you should not drive or operate any machinery. This allows the steroid to remain in the location where the doctor placed it to decrease the inflammation that is causing your discomfort.

The effects of the steroid vary by individual. Most people experience symptom relief for 2 weeks to several months.

A facet joint injection involves the injection of steroid medication into the spinal facet joint to reduce pain caused by inflammation or osteoarthritis. This may also involve injecting small nerves around the facet joint to help pinpoint the source of pain.

A SNRB (Selective Nerve Root Block) is an injection administered at the level of the symptomatic nerve root as it exits the spinal column. This procedure is performed both for diagnostic purposes and to treat radicular pain caused by nerve root irritation. The local anesthetic in the injection provides immediate pain relief, while the corticosteroids reduce inflammation, offering pain relief that may last for weeks to months.

A common condition treated by a SNRB is a herniated disc in the lumbar spine, which causes low back pain and radiating leg pain (sciatica). SNRBs can also be used to determine if a specific nerve root is the source of the pain, allowing physicians to target treatment more precisely.

SI joint injections are often used both to treat pain and to diagnose its source. Fluoroscopic guidance or a CT scan is commonly used to ensure correct needle placement.

During this procedure, the sacroiliac (SI) joint, located between the sacrum and pelvic bones, is injected with a local anesthetic to identify the source of pain. If the injection relieves pain, cortisone and local anesthetics may be injected to treat inflammation from SI joint arthritis. The effects of the injection typically provide temporary relief for several weeks or months.

Spinal injections, are commonly used for pain relief in conditions such as spinal stenosis, herniated discs, radiculopathy, and joint pain. These injections can significantly reduce inflammation and pain, improving mobility and quality of life. However, like any medical procedure, they come with some risks. The risks associated with these injections can range from mild to rare with some having serious complications.

It’s essential for patients to be informed about these risks and discuss them thoroughly with their healthcare provider before proceeding with either of these procedures.

1. Dural Puncture: Accidental puncture of the dural sac, which contains spinal fluid, leading to leakage of spinal fluid into the epidural space.
   
   • Likelihood: Occurs in 1-2% of cases.
   • Symptoms: May cause a spinal headache, which worsens when standing and improves when lying down. The headache usually resolves in a few days but can last longer.
   • Treatment: Most cases resolve with fluid intake and caffeine, and in rare cases, a blood patch may be needed
2. Infection: Minor infection of site.
   • Likelihood: Occurs in less than 2% of cases.
   • Details: Serious infections, including epidural abscesses, are rare but can occur. Diabetic patients are at higher risk of infection.
3. Bleeding / Epidural Hematoma: A large accumulation of blood in the epidural space, which may compress the spinal cord and nerves.
   • Likelihood: Rare, but can occur in patients who are on blood thinners or have clotting disorders.
   • Symptoms: Compression of the spinal cord can cause permanent damage if not treated immediately. Blood thinners should be temporarily paused before the procedure.
4. Nerve or Spinal Cord Damage: Nerve or spinal cord damage may result from needle trauma or compression caused by bleeding or infection.
   • Likelihood: Extremely rare.
   • Details: This can result in permanent nerve or spinal cord injury, and is more likely if there is an infection or hematoma that puts pressure on the spinal cord.
5. Allergic Reaction: An allergic reaction to medications in the injection is rare, and is usually a reaction to the preservatives or contrast dyes used for imaging.
   • Likelihood: Rare.
   • Symptoms: Most reactions are mild (itching, hives), but in rare cases, there may be swelling, especially in the throat.
6. Arachnoiditis: Inflammation of the arachnoid membrane, which is one of the three membranes covering the spinal cord. Arachnoiditis is a painful condition and can be caused by the medication being inadvertently injected into the spinal fluid.
   
   • Likelihood: Extremely rare.
7. Corticosteroid Side Effects: Repeated steroid injections into the same area may weaken tendons, ligaments, and joint cartilage.
   • Likelihood: Generally more common with repeated injections over time.
   • Short-Term Side Effects: May include facial flushing, a feeling of warmth, and elevated blood sugar levels for diabetics.
   • Long-Term Side Effects: Can include osteoporosis, muscle weakness, thinning of skin, stretch marks, weight gain, and redistribution of body fat, among others. These side effects usually resolve after discontinuing steroid use, but some, such as stretch marks and osteoporosis, may persist.
8. Local Side Effects from Steroids: Temporary local side effects, such as irritation or discomfort at the injection site.
   • Likelihood: Common after the injection, but typically resolve on their own.

Spinal injections, are designed to relieve pain and inflammation associated with various spinal conditions. While effective, the use of corticosteroids, especially in high doses, in these injections may lead to side effects, particularly with frequent or high-dose use.

Common systemic side effects of corticosteroid injections include:

• Bone loss (osteoporosis)
• Increased risk of infections
• Elevated blood sugar levels (especially in diabetics)
• Cataracts (rare)
• Thinning of skin
• Stretch marks
• Increased body/facial hair growth
• Acne
• Fluid retention
• Weight gain with fat redistribution (fat deposits may appear on the back and face, while limbs may appear thinner)
• Muscle weakness
• Decreased immunity and resistance to infections
• Stomach ulcers
• Mood swings
• Insomnia
• Suppression of natural cortisol production

Most of these side effects will subside within a few months once the corticosteroid treatment is stopped. However, some—such as stretch marks, osteoporosis, and cataracts (rare) —may persist even after discontinuation of the medication.

Spinal injections, including ESI and various other injection techniques, are effective treatments for reducing inflammation and relieving pain from conditions like spinal stenosis, herniated discs, radicular pain, and other spinal-related issues. These injections can provide significant relief, but like any medical procedure, they come with risks.

While serious complications are rare, possible risks include:

• Loss of bone density
• Decreased immune function
• Changes in adrenal function
• Infection
• Bleeding
• Nerve or spinal cord damage (very rare)
• Allergic reactions to medications used
• Dural puncture (leakage of spinal fluid leading to headaches, typically resolving with rest)

If you are taking blood thinners, it is important to pause them prior to your procedure to minimize the risk of bleeding. Similarly, if you are currently ill or on antibiotics, completing your treatment beforehand is essential.

To reduce the likelihood of side effects, it is recommended that no more than 3-4 steroid injections are administered per year, regardless of the injection site.