Epidural Steroid Injections
The epidural space is composed of fat and blood vessels, and it surrounds the dural sac, which encircles the spinal cord and nerve roots. An epidural steroid injection (ESI) is a minimally invasive procedure used to reduce inflammation and relieve pain caused by conditions affecting the spinal nerves. It involves injecting a corticosteroid (anti-inflammatory medication) and sometimes a local anesthetic into the epidural space—the area around the spinal cord and nerve roots.
Epidural injections are commonly performed in the cervical (neck), thoracic (mid-back), or lumbar (lower back) spine, depending on the location of symptoms.
Who Benefits from Epidural Steroid Injections
You may be a candidate for an epidural steroid injection if you have:
- Radiating pain from the spine to the arms or legs (commonly called radiculopathy or sciatica)
- Herniated disc, degenerative disc disease, or spinal stenosis
- Pain aggravated by activity, prolonged sitting or standing, or specific movements
- Numbness, tingling, or weakness in the limbs
- Poor response to conservative treatments such as physical therapy, oral medications, or rest
ESIs are not a cure, but they can provide significant symptom relief, often to support rehabilitation or avoid surgery.
What to Expect
- Preparation: You’ll be asked to change into a gown. An IV may be started for medication or mild sedation.
- Positioning: Depending on the injection site, you may lie face down or on your side on a special table.
- Sterilization & Numbing: The injection site is cleaned and numbed with a local anesthetic.
- Injection: Using fluoroscopic (X-ray) guidance, the physician inserts a needle into the epidural space closest to the site of the pain and delivers the steroid medication.
- Duration: The procedure typically takes under 10 minutes.
- Pain Level: You may feel pressure or mild discomfort, but the procedure is generally well-tolerated.
You’ll be monitored for about 30 minutes in the recovery room afterward and can usually return home the same day.
After the Procedure
- Immediate Effects: Some people feel temporary numbness or heaviness in the legs (for lumbar ESIs) or arms (for cervical ESIs) due to the anesthetic. Some patients report pain relief within 30 minutes after the injection, but pain may return a few hours later when the anesthetic wears off.
- Delayed Effect: The steroid medication may take up to 14 days to begin reducing inflammation and providing longer-lasting relief. Pain Flare: A brief increase in pain or soreness at the injection site can occur and usually resolves within 24–48 hours.
Recover and Aftercare
- Activity: Rest on the day of the injection. Most people resume light activity within 24 hours, avoiding heavy lifting or strenuous exercise for a few days.
- Ice: Apply an ice pack to the injection site for 15–20 minutes at a time if there’s soreness.
- Medication: Over-the-counter pain relievers may be used as directed. Avoid anti-inflammatory drugs for 24 hours unless advised otherwise.
- Follow-Up: Track your pain relief over the next week. Your provider may recommend additional injections (typically spaced weeks apart) if necessary.
How Long Do Results Last?
Relief varies by person and condition:
- Some experience weeks to months of relief after one injection
If successful, injections may help delay or avoid surgery and support physical rehabilitation
Risks and Considerations
Though generally safe, potential risks include:
- Headache
- Temporary increase in pain
- Infection or bleeding
- Allergic reaction
- Nerve damage (rare)
- Elevation in blood sugar or blood pressure (temporary)
ESIs are typically not recommended for people with active infections, uncontrolled diabetes, bleeding disorders, or certain allergies.