Epidural Steroid Injections

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Dr. Virella is a Board Certified Minimally Invasive Neurosurgeon
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Epidural Steroid Injections


An epidural steroid injection (ESI) is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves. ESI may be performed to relieve pain caused by spinal stenosis, spondylolysis, or disc degeneration or herniation. The effects of ESI tend to be temporary. Pain relief may last for several days or even years. The goal is to reduce pain so that you may resume normal activities and a physical therapy program.

What is an epidural steroid injection (ESI)?


An epidural steroid injection includes both a corticosteroid (e.g., triamcinolone, betamethasone) and occasionally an anesthetic numbing agent (e.g., lidocaine, bupivacaine). The drugs are delivered into the epidural space of the spine, which is the area between the protective covering (dura) of the spinal cord and the bony vertebrae.

Corticosteroid injections can reduce inflammation and can be effective when delivered directly into the painful area. Unfortunately, the injection does not make a herniated disc smaller; it only works on the spinal nerves

There are three ways an ESI can be performed; transforaminal, interlaminar or caudal. The right type of injection depends on your condition and which procedure will likely produce the best results and the least discomfort of side effects. Fluoroscopy (X-ray) is ALWAYS used to ensure both safety and accuracy.

What are the results?


Most patients experience some pain relief from facet injection, on average lasting form 3-4 months. More importantly, the timing of injections should coincide with the start of physical therapy and/or home exercise program to strengthen the back muscles and prevent future pain episodes.

What are the risks?


As with any procedure, there are both potential risks and benefits. ESI is generally safe and serious complications are rare especially when using proper safety techniques such as fluoroscopy. The potential risks associated with inserting the needle include spinal headache from a dural puncture, bleeding, infection, allergic reaction, elevated blood pressure, nerve damage/paralysis (rare) and death. Corticosteroid side effects may cause weight gain, water retention, flushing (hot flashes), mood swings, insomnia, and elevated blood sugar levels in people with diabetes. Any numbness or mild muscle weakness usually resolves within 3-8 hours in the affected arm or leg (similar to the facial numbness experienced after dental work).



Anthony Virella, MD

Anthony Virella, MD


Anthony Virella, MD is a Board-Certified, Fellowship Trained Neurological Spine Surgeon with advanced training in the management spinal disorders. He is also a graduate of the UCLA Neurosurgery Residency Program and completed his Complex Spine Resident Fellowship at the world-renowned Cleveland Clinic Foundation. Additional work included a second Fellowship in Minimally Invasive Spine Surgery at the UCLA Comprehensive Spine Center. Dr. Virella is a nationally recognized spine specialist and has authored numerous articles and lectured nationally and internationally in the field of Complex and Minimally Invasive Spine Surgery.
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Board Certified Neurosurgeon, Dr. Anthony Virella, is a pioneer in Minimally Invasive Spinal Surgery specializing in Cervical Artificial Disc Replacement Procedures. If surgery is recommended, Dr. Virella specializes in minimally invasive procedures that often require an incision of only an inch or less.

Nervous or Apprehensive about taking the first step?

People all over the world delay their treatments due to long-term anxieties and fears surrounding spine surgery and treatments in general. Our practice has worked with many patients over the years and we understand these valid concerns.

Read: A Letter To Patients From Dr. Virella

Relieving your pain should not be a cause for anxiety, and we take every step possible to make sure our patients are comfortable, secure and relaxed from their first visit to their last. Remember, there is nothing scary about taking back control of your life and relieving your pain. Our practice is highly organized and provides step-by-step guided help the entire way to keep you relaxed with your focus where it should be - on you.

You've already taken the first step by searching for the right doctor and can soon be on a path to a pain-free life. Call our practice today (805-449-0088) or request a callback to come and visit with me. We will sit down together and discuss your concerns. Then, I will provide you with a thorough analysis and review of a suggested care path and treatment options.

I pride myself in being extremely attentive to my patients, using extreme caution and putting to work my experience (of nearly two decades) in conservative treatments and minimally invasive procedures that have given thousands of patient their lives back. I have spent my life designing a new approach to spine treatments that reduce any anxieties of my patients by providing them with a comprehensive strategy that makes sense and is proven.

Don't let your pain get worse by delaying getting the help you need. Neglecting needed treatment will (almost certainly) make your situation worse. We hope you decide to take control of your pain and your life. We welcome and look forward to meeting you and having the opportunity to shares our skills and successes with you. Thank you for taking the time to read and we hope to see you soon.

- ANTHONY A. VIRELLA M.D., F.A.C.S
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About Dr. Virella

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  • Los Angeles County
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