Epidural Steroid Injection
A fluoroscopy-guided injection to reduce nerve inflammation and relieve radiating spine pain
An epidural steroid injection (ESI) delivers corticosteroid medication directly into the epidural space surrounding the spinal cord and nerve roots. By reducing inflammation at the site of nerve compression, ESIs can provide significant pain relief for patients with herniated discs, spinal stenosis, and radiculopathy. The procedure is typically performed under fluoroscopic (X-ray) guidance to ensure accurate needle placement. ESIs are not a cure — they are a pain management tool that can reduce inflammation enough for patients to participate in physical therapy and recover more comfortably.
Who Is a Candidate?
- Lumbar or cervical radiculopathy (nerve root pain radiating into the arm or leg)
- Herniated disc with sciatica
- Lumbar or cervical spinal stenosis causing leg or arm pain
- Failed conservative care (physical therapy, NSAIDs) for at least 4–6 weeks
- Pain severe enough to limit participation in rehabilitation
What to Expect
1Before Surgery
Your doctor will review your MRI and confirm the injection target. Inform your physician of all medications, especially blood thinners (aspirin, warfarin, clopidogrel) — you may need to hold these for several days. Most patients do not require fasting, but confirm with your provider. Arrange a driver, as sedation may be offered.
2The Procedure
The procedure is performed in a fluoroscopy suite or operating room. You lie face-down on a table. The skin over the injection site is numbed with local anesthetic. Using live X-ray guidance, the physician advances a needle into the epidural space. Contrast dye is injected to confirm correct placement, then the steroid-anesthetic mixture is administered. The entire procedure typically takes 15–30 minutes.
3Recovery
You will rest for 20–30 minutes in a recovery area. Mild soreness at the injection site is common for 24–48 hours; applying ice helps. You may feel temporary numbness or weakness in the legs — this resolves within hours. Most patients can return to normal activity the next day. Pain relief may begin within 3–7 days as the steroid takes effect.
Typical Outcomes
50–70% of patients report meaningful pain reduction after an epidural steroid injection. Relief typically lasts 3 weeks to 6 months. The procedure can be repeated up to 3 times per year, though repeated steroid exposure carries cumulative risks. ESIs are most effective when combined with physical therapy and are less effective for purely mechanical back pain without a nerve compression component.
Risks & Considerations
- Temporary pain flare at the injection site (common, resolves in 1–2 days)
- Infection (<1%, minimized by sterile technique)
- Dural puncture headache (rare, <1%)
- Temporary elevation in blood sugar (significant for diabetic patients)
- Steroid side effects: flushing, insomnia, temporary mood changes
- Rare: nerve injury, epidural hematoma, or abscess
Frequently Asked Questions
How quickly does an epidural steroid injection work?
Most patients begin to notice pain relief within 3–7 days after the injection as the corticosteroid reduces nerve inflammation. Some people feel immediate relief from the local anesthetic portion, which wears off within hours. Full effect from the steroid is typically reached within 1–2 weeks.
How many epidural steroid injections can I get?
Most spine specialists recommend no more than 3 injections per year at the same spinal level due to cumulative steroid exposure risks, including bone density loss and adrenal suppression. If a single injection provides significant relief, a second or third may be appropriate if symptoms return.
What is the difference between a lumbar interlaminar and a transforaminal injection?
An interlaminar injection delivers steroid into the center of the epidural space between two vertebrae. A transforaminal injection targets the specific nerve root foramen where compression is occurring — it is more targeted but technically more demanding. Your pain management specialist will choose the approach based on your MRI findings.
Will an epidural steroid injection cure my herniated disc?
No. ESIs reduce inflammation and pain but do not physically shrink or remove the herniated disc material. However, most herniated discs improve over 6–12 weeks with or without injections. The injection reduces pain during this natural healing window, allowing patients to maintain activity and participate in physical therapy.
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Medical disclaimer: This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with any questions you may have regarding a medical condition or surgical procedure. Last reviewed April 2026. CPT: 62323.