Epidural Steroid Injections

An epidural steroid injection (ESI) places a strong anti-inflammatory medicine, a corticosteroid, into the epidural space, the area around the spinal nerves inside the spine. It is often combined with a numbing medicine. The goal is to calm swollen, irritated nerves and reduce pain that travels into the arms or legs.

There are three common approaches:

• Interlaminar: the needle enters from the back, between two vertebrae, and the medicine spreads over several levels.
• Transforaminal: the needle is placed next to the opening where one nerve exits the spine, delivering medicine right to that nerve.
• Caudal: the needle enters near the tailbone and the medicine flows upward, often used after prior surgery.

These injections are usually performed by a pain management specialist or interventional physician. Dr. Grunch works closely with trusted pain management specialists and will refer you when an injection is a good next step, either to treat your pain or to help confirm where it is coming from.

• Sciatica and leg pain from a herniated disc
• Arm pain from a pinched nerve in the neck
• Spinal stenosis causing leg pain when walking or standing
• Foraminal stenosis
• Some patients with ongoing pain after back surgery

Epidurals work best for pain that travels into an arm or leg (radicular pain), rather than back or neck pain alone.

• Ask about blood thinners. If you take a blood thinner such as warfarin, apixaban (Eliquis), rivaroxaban (Xarelto), clopidogrel (Plavix) or daily aspirin, tell the doctor doing the injection. Some injections require stopping it for a few days and some do not. Never stop a blood thinner on your own; the doctor who prescribes it will tell you if and when it is safe.
• If you have diabetes, check your blood sugar more often for a few days afterward, because steroid medicine can raise it.
• Tell the team about any allergies, especially to contrast dye, iodine, latex or numbing medicine.
• Reschedule if you have a fever or an infection, or if you might be pregnant.
• Arrange for a driver if you will be given medicine to relax. Many people choose to bring a driver either way.

You will lie on a table, usually face down. The skin is cleaned and numbed. Using live X-ray (fluoroscopy) or sometimes ultrasound, the doctor guides a thin needle to the exact spot. A small amount of contrast dye is often used to confirm the needle position before the medicine is injected. You may feel pressure or a brief, familiar pain. The injection itself usually takes 10 to 30 minutes.

The numbing medicine may give relief, or temporary numbness or heaviness, for a few hours. The steroid usually starts working in 2 to 7 days. Relief can last weeks to months, and for some people it calms a flare long enough for the nerve to heal and for physical therapy to work.

Plan to rest for the rest of the day and return to normal activities the next day. Injections are usually limited to a few per year because of the cumulative effects of steroids. If an epidural does not help, or relief does not last, that is useful information too, and surgery can often correct the problem when a nerve remains pinched.

Epidural injections are commonly done and generally safe. Possible side effects include soreness at the injection site, a temporary rise in blood sugar, flushing, trouble sleeping, and a headache if the needle punctures the covering of the spinal fluid. Infection, bleeding and nerve injury are rare.

Call the doctor who did the injection or go to the emergency room for fever, a severe headache, new weakness or numbness, or loss of bladder or bowel control.

How long does an epidural steroid injection last?

Relief often begins within a week and can last from several weeks to several months. Some people need only one; others need a repeat injection.

Does an epidural injection hurt?

The skin is numbed first. Most people feel pressure and sometimes a brief, familiar pain as the medicine goes in.

How many epidural injections can I have?

Most doctors limit them to a few per year because of the cumulative effects of steroids.

Can an epidural help me avoid surgery?

For some people, yes, especially when the injection calms nerve pain long enough for healing and physical therapy. If a nerve stays pinched, surgery can often correct the problem.

If you have neck pain, back pain or nerve pain and want to know which treatments make sense for you, call 470-293-9800 or contact us to schedule a visit with Dr. Grunch or one of her physician assistants. You can also ask general questions any time through our “Ask Us Anything” chat.

Related: All non-surgical treatment options · Selective nerve root block · Sciatica

This information is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. Please talk to your provider about your symptoms and treatment options.