An epidural steroid injection is an anti-inflammatory placed right next to the irritated nerve root. We guide it with live X-ray.
What is an epidural steroid injection?
The epidural space wraps around the spinal nerves. When a disc herniation inflames a nerve root, much of the pain is chemical, not just pressure. The inflammatory soup around the nerve is doing much of the work. Placing corticosteroid there treats that head-on. The dose is far smaller than pills would need to get the same effect in that spot.
What conditions does an epidural steroid injection treat?
- Sciatica from a lumbar disc herniation
- Cervical radiculopathy with arm pain
- Spinal stenosis with walking limitation
- Lasting pain that shoots down a limb after an accident
What happens during an epidural steroid injection?
- You lie face down. The skin is numbed.
- Live fluoroscopy (moving X-ray) guides the needle. Contrast dye confirms the spot before any medicine is given.
- The injection takes a few minutes. Most people describe pressure rather than pain.
- You rest briefly and go home. No sedation is used, so most patients drive themselves home.
- Relief may be immediate from the local anesthetic, fade after a few hours, then build again over three to seven days as the steroid works.
What are the risks of an epidural steroid injection?
Risks specific to this procedure come first. About one in a hundred get a dural puncture headache. It changes with position, settles with rest and fluids, and now and then needs a blood patch. Short-lived leg heaviness or numbness for a few hours is expected, not alarming. Steroid raises blood glucose for several days. That matters if you are diabetic. It can also cause facial flushing and a few nights of poor sleep. Serious problems are rare: infection, bleeding into the epidural space, or nerve injury. The risk of bleeding rises if you take anticoagulants. So tell us about every blood thinner, including over-the-counter ones.
To talk about whether this is right for you, call us or request an appointment.
How long does an epidural steroid injection take to work?
Judging whether it worked takes two weeks, not an afternoon. The local anesthetic gives quick relief that fades within hours. That early relief confirms the needle was in the right place. It does not predict the result. The steroid effect builds over three to seven days.
Success is not a pain score. It is whether the window let rehab happen: walking farther, sleeping through the night, getting through therapy. An injection that drops pain by half but changes nothing about what you can do has not done much.
Before and after your procedure
No sedation is used, so most patients drive themselves home. If a leg feels weak or numb, have someone else drive until that wears off. Tell us about every blood thinner, including aspirin and fish oil, well before the day. Some need pausing and some do not. That choice is made with the doctor who prescribes them, not by stopping them yourself. Eat lightly beforehand. Afterwards, normal activity, including work, resumes within two to four hours; do not go to bed for a week; ordinary movement from the following day is what the injection is meant to enable. Call us for a headache that is much worse sitting or standing than lying flat, for a fever, or for new weakness.
Common questions
Does it hurt?
Most patients feel pressure and a brief ache, not sharp pain. The skin and deeper tissues are numbed first.
How long does it last?
It varies a great deal: weeks to many months. It is most useful as a window in which rehab can really get done.
Transforaminal Epidural Steroid Injection covers the version that places medication at one specific nerve root.
How many can I have?
There is no magic number. We do not do an automatic series of three. If an injection helps a great deal, we may repeat it when the benefit fades. If it does not help, repeating it is not the answer.
Can I drive after an epidural steroid injection?
Yes, most patients can. No sedation is used, so most patients drive themselves home. If a leg feels weak or numb, have someone else drive until that wears off. After the injection you rest briefly before leaving. Normal activity, including work, resumes within two to four hours. From the next day, normal movement is the goal, because the injection is meant to open a window for walking, sleeping and therapy, not a week in bed.
Do I need to stop my blood thinner before an epidural injection?
Tell us about every blood thinner well before the day, including aspirin, fish oil and over-the-counter products. Some need pausing and some do not. That choice is made with the doctor who prescribes them. So do not stop any of them on your own. Blood thinners raise the risk of bleeding, which is why we ask.
Does an epidural steroid injection raise blood sugar?
Yes. The steroid raises blood glucose for several days. That matters if you have diabetes, so expect higher readings for those few days. Some people also notice facial flushing or a few nights of poor sleep. Like the rise in blood sugar, these effects pass.
What should I watch for after an epidural steroid injection?
Some leg heaviness or numbness for a few hours is expected. Call us for a headache that is much worse sitting or standing than lying flat, for a fever, or for new weakness. That kind of headache follows about one in a hundred injections. It settles with rest and fluids, and now and then needs a blood patch.
Why do I feel worse after an epidural steroid injection?
Usually it is timing. The numbing medicine wears off the same day, the steroid has not started working yet, and the needle site aches on top of the returning pain, so the first evening can feel like a step backward. A few nights of steroid-disturbed sleep make it louder, because a tired nervous system amplifies every pain signal. None of that predicts the result; judge it at two weeks, by how far you walk and how well you sleep. If the pain runs down your leg, sciatica explains what inflamed the nerve root in the first place.
Sources
- Mahmoud AM et al. A systematic review and network meta-analysis comparing different epidural steroid injection approaches. Pain practice : the official journal of World Institute of Pain, 2024. PubMed 37700550
- Lee JH et al. Comparison of Clinical Efficacy of Transforaminal and Interlaminar Epidural Steroid Injection in Radicular Pain due to Cervical Diseases: A Systematic Review and Meta-analysis. Pain physician, 2022. PubMed 36608007
- Lee JH et al. Comparison of clinical efficacy of transforaminal and caudal epidural steroid injection in lumbar and lumbosacral disc herniation: A systematic review and meta-analysis. The spine journal : official journal of the North American Spine Society, 2018. PubMed 30030083
- Armon C et al. Epidural Steroids for Cervical and Lumbar Radicular Pain and Spinal Stenosis Systematic Review Summary: Report of the AAN Guidelines Subcommittee. Neurology, 2025. PubMed 39938000
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