06 Oct Understanding Epidural Steroid Injections (ESI) vs. Rhizotomy: Which Is Right for You?
If you’re living with chronic back or neck pain, your pain management specialist may recommend one of two common procedures: the Epidural Steroid Injection (ESI) or Radiofrequency Ablation (RFA), often called Rhizotomy.
Both treatments can significantly reduce discomfort — but they work in very different ways. Think of ESI as a fast-acting, short-term option that calms inflamed nerves, while Rhizotomy (RFA) is a longer-term solution that quiets the small nerves transmitting chronic joint pain.
Understanding how these two procedures differ — what they treat, how they work, and how long they last — can help you and your doctor build the best plan for lasting pain management.
Part 1: The Quick Relief — Epidural Steroid Injection (ESI)
An Epidural Steroid Injection is one of the most frequently used pain management procedures, especially for nerve-related pain such as sciatica or discomfort caused by a bulging or herniated disc.
How ESI Works
An ESI is an anti-inflammatory injection that delivers medication directly to the irritated nerve area.
- Target Area: The injection goes into the epidural space — the area surrounding the spinal cord and nerve roots. When a disc is swollen or injured, it can press on nearby nerves, causing inflammation and radiating pain down an arm or leg.
- Medication Used: The injection contains a corticosteroid (a potent anti-inflammatory agent) and a small amount of anesthetic to alleviate irritation and reduce swelling.
How Long ESI Relief Lasts
ESI is designed to provide temporary relief from inflammation and nerve pain, allowing you to participate in physical therapy or daily activities with greater ease.
- Relief can last from several weeks to a few months, depending on the condition and your body’s response.
- While ESI doesn’t correct the structural issue causing the nerve compression, it helps manage pain and can confirm that a specific nerve is the true source of discomfort.
Why Technique Matters
Not all injections are performed the same way — and precision makes a difference.
- Transforaminal Approach: This advanced technique delivers medication directly to the nerve’s exit point in the spine, often leading to better short-term results.
- Medication Concentration: Using a smaller volume of highly concentrated medication can sometimes provide more effective relief and minimize the need for additional procedures.
Part 2: The Long-Term Solution — Rhizotomy (Radiofrequency Ablation, RFA)
Rhizotomy, also known as Radiofrequency Ablation (RFA), is a longer-lasting procedure designed for chronic joint pain, rather than nerve compression. It is particularly helpful for pain originating from the facet joints in the spine or the sacroiliac (SI) joints in the pelvis.
How RFA Works
RFA targets the small nerves that carry pain signals from the joints to the brain.
- The Target: The procedure focuses on the medial branch nerves that send pain signals from the inflamed facet joints.
- The Process: Using precise, image-guided placement, the doctor applies a controlled radiofrequency current through a small needle to create gentle heat at the nerve site.
- The Effect: This heat temporarily interrupts the nerve’s ability to send pain messages, allowing significant relief for an extended period.
How Long RFA Relief Lasts
RFA is known for providing longer-term pain relief because it affects the nerve’s ability to function.
- Relief can last for many months to a year or longer, depending on how quickly the nerve regenerates.
- When pain returns, the procedure can often be safely repeated.
RFA gives patients the opportunity to move, exercise, and strengthen without constant joint pain interfering with daily life.
Part 3: Why You Often Need One Before the Other
ESI and RFA are not competing treatments — they’re often used in sequence as part of a long-term care plan.
Step 1: ESI or Diagnostic Nerve Block
Before your specialist performs RFA, they must first confirm the exact location of the pain source. This is achieved through a diagnostic nerve block, which functions similarly to a short-acting ESI.
- If you experience strong temporary relief after the diagnostic injection, it confirms that the targeted nerve or joint is the correct source of pain.
- If the pain doesn’t change, your doctor knows the source lies elsewhere, and RFA would not be appropriate.
Step 2: RFA for Confirmed Pain Sources
Once the diagnostic test confirms the right nerve, you may be a candidate for RFA. This step-by-step process ensures that RFA is applied with precision — increasing the likelihood of effective, lasting results.
Comparison at a Glance
| Feature | Epidural Steroid Injection (ESI) | Radiofrequency Ablation (RFA/Rhizotomy) |
| Primary Goal | Short-term pain relief and diagnostic confirmation (for nerve pain) | Long-term reduction of chronic joint pain signals |
| Pain Source Treated | Pinched or inflamed nerves (e.g., sciatica, herniated disc) | Arthritic or inflamed joints (e.g., facet or SI joints) |
| Mechanism | Anti-inflammatory medication reduces swelling | Controlled heat disrupts pain signal transmission |
| Duration of Relief | Weeks to a few months | Many months to over a year |
| Prerequisite | Often the first diagnostic step | Requires successful confirmation from a diagnostic block |
Finding Your Best Path Forward
The decision between an Epidural Steroid Injection and Radiofrequency Ablation depends on what’s actually causing your pain.
If your discomfort is due to nerve irritation or inflammation, an ESI may be the right first step. If your pain originates from arthritic or inflamed joints, and a diagnostic test confirms this, RFA may provide longer-term relief.
Working closely with an experienced pain management specialist ensures that your treatment plan is customized, accurate, and designed for sustainable comfort and function.
At Principal Spine & Pain Management Consultants, Dr. Paul Kurian offers both ESI and RFA procedures, performed with precision and care, to help patients throughout North Dallas regain confidence and control in their daily lives.