Spinal injections
Epidural steroid injection
The epidural space lies just outside the membrane covering the spinal cord and nerve roots. An epidural steroid injection places corticosteroid, usually with a local anaesthetic, into that space near a nerve root that has become inflamed — most often by a disc herniation or by narrowing of the spinal canal. The aim is to reduce inflammation around the nerve and so reduce the pain it refers into the arm or the leg. It treats the inflammation, not the disc.
What the procedure involves
An outpatient procedure, performed with the patient awake and usually taking a few minutes once positioning is complete.
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Positioning and skin preparation
The patient is positioned to open the target level, and the skin is cleaned and anaesthetised with local anaesthetic.
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Image guidance
Fluoroscopy — real-time X-ray — is used to guide the needle to the intended level. Contrast may be injected first to confirm placement before medication is given.
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Injection
Corticosteroid, usually combined with local anaesthetic, is delivered into the epidural space. Pressure is commonly felt; sharp pain is not expected and should be reported during the procedure.
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Observation and discharge
A short period of observation follows. Arrangements for transport home are usual, and normal activity is generally resumed the following day unless advised otherwise.
Risks and side effects
Serious complications are uncommon, but the procedure is not without risk and the steroid itself has systemic effects.
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Common and temporary
Soreness at the injection site, a short-lived increase in pain before improvement, flushing, and difficulty sleeping for a night or two.
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Steroid-related effects
A temporary rise in blood glucose, which matters for people with diabetes; fluid retention; and, with repeated injections, effects on bone density. This is part of why the number of injections in a period is limited.
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Procedural complications
Dural puncture and the headache that can follow it, bleeding, infection, and — rarely — nerve injury. Image guidance and screening for anticoagulation reduce but do not eliminate these risks.
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Limited duration of benefit
Relief varies from weeks to months and is not permanent. The injection is generally used to create a window in which rehabilitation can progress, rather than as a treatment on its own.
Common questions
Is the injection painful?
The skin is anaesthetised first, and most people describe pressure rather than sharp pain. Soreness at the site for a day or two afterwards is common.
How soon does it work, and how long does it last?
Local anaesthetic may provide some relief within hours, but the steroid effect usually develops over several days. Duration varies from weeks to months and differs considerably between individuals.
How many can be given?
The number in any period is limited because of the cumulative effects of corticosteroid. The specific limit depends on the individual, the dose and the response to previous injections.
Does it fix the disc?
No. It reduces inflammation around the affected nerve root. The underlying disc herniation or stenosis remains, although many herniations reduce on their own over time.
What is the difference between this and a nerve block?
An epidural injection places anti-inflammatory medication into the epidural space to calm an irritated root. A nerve block places local anaesthetic around a specific nerve, often primarily to establish whether that nerve is carrying the pain.
General reference information, and not advice about your own case. It may not reflect the most recent guidance or what is offered on a given day — call (201) 408-5151 to check.
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