Epidural steroid injections for back, neck, arm and leg pain

Overview

An epidural steroid injection, often called an ESI or "epidural," puts anti-inflammatory medicine near an irritated nerve in your spine. It is used for pain that travels, such as sciatica down the leg or pain from the neck into the arm. The goal is to calm the irritation so the pain eases enough for you to move, sleep and do your therapy. For some people the relief lasts weeks to months. For others it is shorter, or it does not help much.

GSMC is led by Dr. Dharam Mann, who completed fellowships in pain management, cardiac anesthesia and critical care at Massachusetts General Hospital/Harvard.

Watch: how Epidural Steroid Injection works

Video: “What You Should Know: Lumbar Epidural Steroid Injections” from NASSspine on YouTube. It loads from youtube-nocookie.com only when you press play. Shown for general education; GSMC did not produce it. Watch on YouTube

What it is

The epidural space is the area just around the covering of the spinal cord and nerve roots. In an ESI, a corticosteroid (an anti-inflammatory medicine) is placed there, often with a numbing medicine. There are three common ways to reach this space:

• Interlaminar: from the back, between two bones
• Transforaminal: from the side, near the opening where one nerve leaves the spine
• Caudal: through a small opening near the tailbone

Your physician chooses the approach based on where your pain is and what your imaging shows.

Who it's for

An ESI may help people with:

• Sciatica or leg pain from a herniated disc
• Arm pain from a pinched nerve in the neck (cervical radiculopathy)
• Spinal stenosis with leg pain when walking
• Nerve pain that has not improved enough with rest, therapy or medicines

What the procedure involves, step by step

1. Before: we review your imaging, allergies and medicines. Blood thinners may need to be paused, but only with approval from the doctor who prescribes them. Plan to have a driver.
2. Getting ready: you lie on a procedure table, usually on your stomach. The skin is cleaned and numbed.
3. Guidance: using live X-ray (fluoroscopy), and often a small amount of contrast dye, your physician guides a thin needle to the right spot.
4. Medicine: the steroid, often with a numbing medicine, is injected. The injection itself usually takes about 10 to 15 minutes.
5. After: you rest for a short time while we check on you, then go home the same day.

Recovery and what to expect

• The numbing medicine wears off within a few hours. Your pain may return for a short time.
• The steroid may take a few days, and sometimes up to a week or two, to start working.
• Most people return to light activity the next day.
• Some people notice flushing of the face, trouble sleeping or a short rise in blood sugar. If you have diabetes, check your sugar more often for a few days.
• Keep a pain diary. It helps us judge how well the injection worked and plan next steps.

Candidacy: who may or may not be a good fit

May be a good fit: people whose arm or leg pain matches a pinched or inflamed nerve on their exam and imaging, and who have not improved enough with conservative care.

May not be a good fit: people with an active infection, a bleeding disorder or blood thinners that cannot be safely paused, poorly controlled diabetes, an allergy to the medicines used, or pregnancy. Steroid injections are also usually limited to a few per year, so the number you have already had matters.

Risks in brief

Every procedure has risks. These include soreness at the injection site, a short-term increase in pain, bleeding or bruising, and side effects of the steroid such as a rise in blood sugar. Less common risks include infection and a headache from a spinal fluid leak. Allergic reaction and nerve injury are rare. Very rarely, serious problems such as bleeding near the spinal cord or stroke-like injury can occur. Our physicians will go over your specific risks.

Alternatives

Other options may include physical therapy, medicines, activity changes, selective nerve root blocks, spinal cord stimulation or, for some people, surgery. For spinal stenosis, the mild® procedure or an interspinous spacer may be options.

Frequently asked questions

Insurance

GSMC participates with all Aetna plans, including Aetna HMO, and with many other insurance plans. Coverage for a specific procedure depends on your plan and may need prior authorization; call 732-202-3000 to verify. Our team can help check your benefits before treatment.

See accepted insurance

Related pages

Related conditions

• Spinal stenosis
• Sciatica
• Disc herniation
• Cervical radiculopathy (pinched neck nerve)
• Post-Laminectomy Syndrome

Related treatments and resources

• Spinal nerve root blocks
• MILD procedure
• Interspinous spacer (Vertiflex / Superion)
• Blog: Epidural steroid injection, what to expect
• Blog: Spinal stenosis treatment without surgery