Epidural Steroid Injection 

What is an epidural steroid injection?

An epidural steroid injection is a targeted minimally invasive procedure consisting of a corticosteroid that can help relieve radicular pain in the neck, arm, back, and legs. The doctor will use x-ray guidance to place a small needle into the area(s) that correspond to your pain complaint. The corticosteroid is injected into the epidural space (the space between the disc, spinal cord, and spinal nerve), along with a local anesthetic medicine (like lidocaine) to provide pain relief.

How is it done?

A needle is directed into the epidural space under X-ray guidance. Moderate sedation and/or a local anesthetic may be used to ensure the patient's comfort. A small amount of X-ray dye is injected to confirm epidural placement of the needle. Then a mixture of steroids and local anesthetic is injected. This feels like a pressure or "fullness" along the path of the irritated nerve root. The needle is then removed and the patient is taken to the recovery room.

Ready to see some of Georgia's best pain prevention specialist? 

icon

Cervical Epidural Steroid Injection

This injection relieves pain in the neck, shoulders, and arms caused by a pinched nerve (or nerves) in the cervical spine. Conditions such as herniated discs and spinal stenosis can compress nerves, causing inflammation and pain. The medication injected helps decrease the swelling of nerves.

Lumbar Epidural Steroid Injection

The lumbar epidural steroid injection procedure is performed to relieve low back and radiating leg pain. Steroid medication can reduce the swelling and inflammation caused by spinal conditions.

Epidural Steroid Injections FAQ 

What is an epidural steroid injection?

An epidural steroid injection is a targeted minimally invasive procedure consisting of a corticosteroid that can help relieve radicular pain in the neck, arm, back, and leg. The doctor will use x-ray guidance to place 1-3 needles into the area(s) that correspond to your pain complaint. The doctor will then use a small amount of contrast dye to ensure the medication will spread to the appropriate area. The corticosteroid is injected into the epidural space (the space between the disc, spinal cord, and spinal nerve), along with a local anesthetic medicine (like lidocaine) to provide pain relief.

How is it done?

A needle is directed into the epidural space under X-ray guidance. Moderate sedation and/or a local anesthetic may be used to ensure the patient's comfort. A small amount of X-ray dye is injected to confirm epidural placement of the needle. Then a mixture of steroids and local anesthetic is injected. This feels like a pressure or "fullness" along the path of the irritated nerve root. The needle is then removed and the patient is taken to the recovery room.

Risk?

As with any invasive procedure there are some associated risks and complications. Any time a needle is put into the body, there is a risk of infection or bleeding, or allergic reaction. The risk of infection is reduced by using sterile techniques. The risk of bleeding is very minimal if you are not on any blood thinners. There are very few allergic reactions to the medications that are used for the injection. If any allergic reactions are identified, medications will be given and you will be observed to prevent any serious complications. Steroids may have several side effects but are limited due to the small amount of medication used in the procedure.

In the low back, there are risks of back pain, headache, worsening the pain, not helping the pain, and causing persistent numbness and/or weakness. In most individuals, the spinal cord ends at L1-2, so any injections below those levels have essentially no risk of spinal cord injury or paralysis.

Cervical Epidural Steroid Injection

This injection relieves pain in the neck, shoulders, and arms caused by a pinched nerve (or nerves) in the cervical spine. Conditions such as herniated discs and spinal stenosis can compress nerves, causing inflammation and pain. The medication injected helps decrease the swelling of nerves.

Patient Sedated

The procedure is performed with the patient lying down. Intravenous sedation may be administered, and a region of skin and tissue of the neck is numbed with a local anesthetic delivered through a small needle.

an image involving standing table sitting

Needle Inserted

Using x-ray guidance (also called fluoroscopy), the physician guides a larger needle to the painful area of the neck. The needle is inserted into the epidural space, which is the region through which spinal nerves travel.

Contrast Dye Injected

Contrast dye is injected into the space to make sure the needle is properly positioned near the irritated nerve or nerves.

Steroid Injected

A combination of an anesthetic and cortisone steroid solution is injected into the epidural space. The steroid is an anti inflammatory medication. It is absorbed by the inflamed nerves to decrease swelling and relieve pressure. The needle is removed and a small bandage is applied.

End of Procedure

The patient goes to a recovery room and is given food and drink and discharged with post treatment instructions. Some patients may need only one injection, but it may take two or three injections (administered weeks apart) to provide significant pain relief.

Lumbar Epidural Steroid Injection

The lumbar epidural steroid injection procedure is performed to relieve low back and radiating leg pain. Steroid medication can reduce the swelling and inflammation caused by spinal conditions.

Patient Positioning

The patient lies face down. A cushion under the stomach area provides comfort and flexes the back. In this position, the spine opens and allows for easier access to the epidural space.

Tissue Anesthetized

A local anesthetic is used to numb the skin. All the tissue down to the surface of the lamina portion of the lumbar vertebra bone is anesthetized. The physician slides a thicker needle through the anesthetized track.

Fluoroscopic Guidance

Using a fluoroscope for guidance, the physician slides the needle toward the epidural space between the L-4 and L-5 vertebra. A contrast solution is injected. The physician uses the fluoroscope to confirm the correct location of the needle tip.

Steroids Injected

A steroid-anesthetics mix is injected into the epidural space, bathing the painful nerve root with soothing medication.

End of Procedure

The needle is removed, and a small bandage is applied to cover the tiny needle surface wound. In some cases it may be necessary to repeat the procedure as many as three times to get the full benefit of the medication. Many patients get significant relief from only one or two injections.