Image-guided injections
Epidural Steroid Injections
Targeted anti-inflammatory treatment around spinal nerves
Epidural steroid injections deliver anti-inflammatory medication around an irritated spinal nerve through an interlaminar, transforaminal, or caudal approach selected for the anatomy and symptom pattern.
This guide is educational and cannot determine candidacy. Every treatment has limitations and risks, and outcomes are not guaranteed. A clinician must review your diagnosis, health history, imaging, medicines, and goals.
What it targets
A procedure built for a particular pain mechanism.
A disc herniation or narrowed spinal canal can inflame and irritate a nerve root, producing pain that travels into an arm or leg. Under fluoroscopic guidance, medication is placed in the epidural space to reduce inflammation. The injection does not remove a disc herniation or permanently enlarge a narrowed canal.
Who may be evaluated
Candidacy begins with diagnostic fit.
Evidence is strongest for short-term relief of radicular pain. Epidural injections are not a routine solution for every form of isolated axial neck or low-back pain.
Clinical considerations
- Cervical, thoracic, or lumbar radicular pain that matches examination and imaging
- Disc herniation, foraminal narrowing, or spinal stenosis with nerve-root inflammation
- Persistent symptoms despite initial medication, activity modification, and rehabilitation
- A goal such as reducing pain enough to restore sleep, movement, or participation in therapy
- No uncontrolled infection, bleeding risk, or progressive neurologic emergency
Evaluation may include
- Neurologic history and examination, including strength, sensation, and reflexes
- MRI or CT review when indicated to select the safest and most relevant approach
- Medication and allergy review, especially anticoagulants, antiplatelets, diabetes therapies, and contrast reactions
- Screening for red flags that require urgent surgical or medical evaluation
How it is performed
The procedure, step by step.
Approach selection
Interlaminar, transforaminal, or caudal access is selected according to the affected level, pain distribution, prior surgery, and safety considerations.
Image-guided placement
After the skin is numbed, a needle is guided into the epidural space with fluoroscopy; contrast is commonly used to confirm spread.
Medication delivery
A corticosteroid, often with local anesthetic, is injected and the patient is observed before discharge.
After the procedure
Recovery, follow-up, and important risks.
Recovery & follow-up
- Temporary heaviness, numbness, or pain change can occur from the local anesthetic.
- The anti-inflammatory effect may take several days and is evaluated alongside functional change.
- Blood sugar may rise temporarily in patients with diabetes.
- The number and timing of repeat injections depend on response, steroid exposure, diagnosis, and coverage criteria.
Risks & limitations
- Bleeding, infection, allergic reaction, dural puncture headache, and temporary pain flare
- Steroid effects such as elevated blood glucose, flushing, fluid retention, or sleep disturbance
- Rare but serious neurologic injury, stroke, paralysis, vision loss, or death
- Limited or short-lived benefit and no prevention of future surgery when structural disease progresses
Alternatives to discuss
Evidence & technology
What is established—and what is still being studied.
Evidence in context
Systematic reviews generally find small to modest short-term improvement for radicular pain and less support for durable long-term benefit. Corticosteroids are not FDA-approved specifically for epidural administration; this common use is off-label and carries rare serious neurologic risks.
Brands are examples, not endorsements
Medication formulation and approach are selected by the physician. Particulate and non-particulate steroids have different risk considerations, especially for cervical transforaminal injections; no drug brand is presented as universally preferred.
Common questions
A useful conversation starts here.
Related patient guides
Compare nearby clinical pathways.
Bring the questions with you
Find out whether the diagnosis fits the treatment.
Request an evaluation at one of our three South Florida offices.