What Is an Epidural Steroid Injection?
An epidural steroid injection (ESI) is a minimally invasive treatment used to relieve pain caused by irritated or inflamed spinal nerves. Conditions such as spinal stenosis or a herniated disc can cause pain in the neck, back, arms, or legs.
Using imaging guidance, physicians at CLS Health Pain Management carefully deliver anti-inflammatory medication and a numbing medicine into the space around the affected nerves. Relief varies, but it may last for weeks to months and help patients return to physical therapy and everyday activities.
How Epidural Steroid Injections Work
The corticosteroid medication reduces inflammation around the affected nerves, while the numbing medicine may provide temporary relief shortly after the procedure. An ESI does not repair the underlying disc or structural condition, but reducing inflammation may make movement, exercise, and physical therapy more comfortable.
What Conditions Can an ESI Treat?
ESIs are generally most helpful when spinal nerve inflammation causes pain that travels into an arm or leg. Your provider will review your symptoms, examination findings, and imaging to determine whether an injection is appropriate.
Epidural steroid injections may be considered for pain related to:
- Herniated or bulging discs
- Spinal stenosis
- Sciatica
- Cervical or lumbar radiculopathy
- Degenerative disc disease
- Failed back surgery syndrome or post-laminectomy pain
Types of Epidural Steroid Injections
- Lumbar Epidural Steroid Injections
Used to treat lower back pain and sciatica (pain that radiates down the leg). - Caudal Epidural Steroid Injections
Target lower-back pain, including pain associated with failed back surgery syndrome, also called post-laminectomy syndrome. - Thoracic Epidural Steroid Injections
Treat pain in the mid-back and can help relieve pain radiating to the chest or upper abdomen. - Cervical Epidural Steroid Injections
Used for neck pain, as well as pain radiating to the shoulders, arms, or hands.
Preparing for Your Procedure
Your doctor will review your medical history and imaging to determine the injection site. You’re encouraged to ask questions before the procedure. A contrast dye is used to guide needle placement—please inform your doctor if you have any dye allergies. If you take blood-thinning medication, your care team will coordinate with your primary care provider or cardiologist because you may need to pause certain medications before the procedure. Do not stop any medication unless instructed by your healthcare provider.
The procedure takes place in our advanced in-office procedure room. Be sure to arrange for an adult to drive you home afterward.
What to Expect During the Procedure
Before the procedure, you’ll sign a consent form. The injection typically takes 15 to 45 minutes, followed by a short observation period. Your doctor will place the medication as close to the affected nerve as possible, using a technique tailored to your condition and any prior spinal surgeries. The goal is to deliver precise, effective relief.
Step 1: Preparation
While lying on an x-ray table, your skin will be numbed in the treatment area to minimize discomfort during the procedure. You will usually remain awake so you can provide feedback during the procedure. If you are concerned about discomfort or think you may need sedation, discuss your options with your physician beforehand.
Step 2: Needle Placement
Using fluoroscopy, a type of real-time X-ray guidance, your doctor carefully guides the needle into the epidural space. A small amount of contrast material is usually used to confirm that the needle is positioned correctly. You may feel pressure during this step, but the treatment area will be numbed to help minimize discomfort.
Step 3: Medication Injection
When the needle is in the correct location, the anesthetic (numbing) agent and steroids are injected, then the needle is removed.
Aftercare and Recovery Timeline
Most patients can walk and leave the clinic after a brief observation period, but an adult should drive you home.
Unless instructed otherwise, you may be able to resume normal activities the following day. Temporary injection-site soreness or increased pain may occur and can often be managed with an ice pack and acetaminophen, if approved by your provider.
Numbness or weakness related to the local anesthetic should resolve as the medication wears off. The steroid typically begins taking effect over the first one to two weeks. Contact your provider if numbness or weakness persists or worsens.
You’ll receive a pain diary to track your symptoms over the next two weeks. This helps your provider assess how well the injection is working and determine any next steps.
Risks, Complications, and Contraindications
Epidural steroid injections are generally well tolerated, but all medical procedures carry potential risks.
Possible minor effects include:
- Temporary increased pain
- Injection-site soreness
- Numbness that lasts longer than expected
Minor side effects and complication rates vary depending on the injection technique, treatment area, and individual patient factors. Serious neurological complications are rare but can include vision loss, stroke, paralysis, or death. Your provider uses imaging guidance and reviews your health history to reduce procedural risks.
An epidural steroid injection may not be appropriate for patients with:
- An active infection
- A significant bleeding or clotting disorder
- An allergy to the medications or contrast material used
- Pregnancy or possible pregnancy
Your provider will review your medical history, medications, and individual risks before recommending treatment.
Expected Results and Next Steps
Response to an epidural steroid injection varies. Some patients experience relief lasting weeks to months, while others may have limited improvement. Additional injections may be considered based on your clinical response, the degree and duration of relief, and whether the pain returns. Epidural steroid injections are generally limited to no more than four per year.
When pain relief allows, physical therapy or a home exercise program may help improve strength, movement, and long-term spine health.
Epidural Steroid Injection FAQs
The treatment area is numbed beforehand to minimize discomfort. You may feel pressure, tingling, or brief discomfort as the needle is positioned and the medication is delivered.
The numbing medication may provide temporary relief shortly after the procedure. The steroid usually begins reducing inflammation over the first one to two weeks.
Relief varies by patient and condition but may last from several weeks to several months. Additional injections may extend the benefit for some patients based on their response.
You should arrange for an adult to drive you home after the procedure. Temporary numbness, weakness, sedation, or discomfort may make driving unsafe.
Additional injections are considered based on how much relief you experience, how long it lasts, and whether the pain returns. Epidural steroid injections are generally limited to no more than four per year.
Many patients can resume routine activities the following day. Your provider may recommend temporarily avoiding strenuous exercise, heavy lifting, or activities that increase your pain.
Contact your provider if you experience little or no improvement. Your provider can reassess the cause of your pain and determine whether another injection, physical therapy, medication, additional imaging, or a different treatment may be appropriate.
Find Out Whether an Epidural Steroid Injection Is Right for You
If neck, back, arm, or leg pain is affecting your daily activities, a pain management specialist can evaluate the cause and determine whether an epidural steroid injection may help.
Book with Dr. Mian
Interventional Pain Medicine, Pain Medicine
