What You Need to Know About Epidural Steroid Injections

Spinal injections have been used for over 100 years to treat back pain. An epidural steroid injection (ESI) is a minimally invasive procedure typically used to alleviate low back pain and/or leg pain. This type of spinal injection has become widely used today as one of the most common nonsurgical methods for managing back pain. During the procedure, medicines are delivered to the spinal nerve through the epidural space. Pain relief could last anywhere from several days to years. Unfortunately, its effects are temporary, but the goal of an ESI is to reduce pain so patients are able to resume normal activities. More severe back pain can require multiple injections over a few weeks.

Epidurals reduce pain by delivering steroids directly to the painful area in the spine to help decrease inflammation that may be causing the pain. These injections are especially helpful in relieving pain that radiates from the spine to an arm or leg.

Who should get an ESI?

There are several common conditions that could be helped by an epidural steroid injection, including:

  • Lumbar disc herniation: the annulus fibrosus around the disc degenerates, causing the gel-like material inside the spinal disc to swell or rupture. This results in pain and inflammation when coming in contact with a spinal nerve.
  • Degenerative disc disease: this pain is caused by spinal discs wearing down as you age. Spinal discs become flatter and, as a result, do not absorb shock as well.
  • Lumbar spinal stenosis: aging brings a degeneration of the vertebrae, discs, muscles, and ligaments. These changes cause leg pain and other symptoms when the spinal nerves in the lower back are choked.
  • Sciatica: describes the symptoms of leg pain that originate in the lower back and shoot down the sciatic nerve in the legs. Sciatica symptoms can be caused by all of the above medical diagnoses.


The benefits of epidural steroid injections greatly outweigh the risks. Recent research shows that ESIs are successful in patients with sciatica from lumbar disc herniation, with over 80 percent experiencing relief. Since the steroid medication is administered directly to the inflamed area, many patients feel an immediate change. Patients feel a reduction in pain, primarily in leg or sciatica pain. It is difficult to predict the length of time it takes an ESI to reduce pain, with patients reporting relief from two days to two months to two years. Pain relief length can vary depending on the patient’s condition and the severity of pain. Patients have found an ESI coupled with an organized therapeutic exercise program can achieve a greater result.


Although epidural steroid injections are successful in relieving pain for 50 to 75 percent of patients, there are potential risks and side effects. The risks are rare and may include infection, bleeding, nerve damage, and dural puncture. There are potential side effects as well from the steroid medication. The side effects may include decrease in immunity, high blood sugar, stomach ulcers, arthritis of the hips, cataracts, transient flushing, and increased appetite. Many of these risks can occur when a fluoroscopy (live x-ray) and radiographic contrast are NOT used to ensure accurate placement of the steroid solution.

What to expect

As your physician will tell you, preparing for an injection is important. Anti-inflammatory or blood thinning drugs should not be taken the week before your injection. You should also plan to have a ride home from the injection. After the procedure, it’s possible for the leg to feel slightly numb.

Before the injection

The procedure should only take about 15 to 30 minutes. The patient will lie flat on his or her stomach on the x-ray table. Prior to the injection, the skin will be numbed with lidocaine. Next, using fluoroscopy, the physician will direct the needle toward the epidural space.

During and after the injection

The epidural steroid solution is injected once the needle is in the correct position. For about 15 to 20 minutes after the injection, the patient will be monitored before being discharged to go home. After the injection, it is best to rest and take it easy, and normal activities can resume the following day.

If you’re considering an epidural steroid injection or are looking for other nonsurgical options for back pain relief, feel free to contact us!

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