Procedures · Interventional pain

Epidural steroid injections

An epidural steroid injection places anti-inflammatory medicine around an irritated nerve through a needle, guided by live X-ray. There is no incision and very little recovery. For most people it is the next step after physical therapy and medication, and for many it is the only treatment they need.

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Why you are here

Conditions an injection can help

These are different diagnoses that cause different symptoms. Each can involve an inflamed nerve in a space a needle can reach.

Lumbar transforaminal epidural steroid injectionThe animation shows the lumbar transforaminal route, which is the most common. 1:52.

What it does

It treats the inflammation, and it tells us where the problem is

An injection can also show which level is causing your pain.

What it does
Steroid placed next to an inflamed nerve root calms the irritation causing most of the pain. Pain usually eases over a few days to a couple of weeks, which can make physical therapy possible for people who could not manage it before.
What it does not do
It does not remove a disc fragment, widen a narrowed canal or change anything on your MRI. Where the pressure on the nerve is severe, an injection may relieve pain for a while without fixing the cause.
What it tells us
If an injection at one level takes the leg pain away, that is strong evidence that that level is the cause. When an MRI shows changes at three levels and the symptoms could come from any of them, an injection is often the clearest way to find out, which is why it usually comes before surgery is considered.
How many
Usually up to about three in a year, spaced out, and only repeated if the last one helped. If an injection did not help, the diagnosis is looked at again before anything is repeated.
Three routes

The needle reaches the same space three different ways

Which one is used depends on where the inflammation is, on what has been done to your spine before, and on what the live X-ray shows on the day.

Transforaminal
Through the opening where the nerve root leaves the spine, so the medicine reaches that one root directly. It is the most precise of the three and the most useful for diagnosis, because it targets a single level.
Interlaminar
Between the bony plates at the back of the spine, into the epidural space. The medicine spreads more widely than with a transforaminal injection, which helps when several nerve roots are involved.
Caudal
Through the natural opening at the very bottom of the sacrum, below the levels of interest. Useful when scarring from previous surgery makes the space above difficult to enter safely.
On the day

What to expect

Setting
Outpatient, under live X-ray
Anesthetic
Local, often with light sedation
Time in the room
About 15–30 minutes
Home
The same day, with a driver
Back to work
Usually the next day
When it works
Days to about two weeks

These are general ranges from the interventional pain literature and from routine practice, and they cannot be guaranteed for any one person. Blood thinners have to be discussed before booking, and an injection is put off if there is any active infection. If you develop a fever, worsening weakness, or new trouble controlling your bladder or bowels after an injection, do not wait: call the office or go to the emergency department.

What happens next depends on how you respond

A good, lasting response means the inflammation was the problem and it has been treated. A good but short-lived response confirms the level but suggests the nerve is being pressed on, and that is when surgery may be discussed. If the injection does not help at all, the pain is probably coming from somewhere else, most often the facet joints, the vertebral body or the sacroiliac joint, and each of these has a different treatment.

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