What Are Epidural Steroid Injections?
Epidural steroid injections (ESIs) are one of the most commonly performed and well-studied pain management procedures available. The treatment delivers a combination of a corticosteroid (anti-inflammatory medication) and a local anesthetic directly into the epidural space — the area surrounding the protective lining of the spinal cord. By targeting inflamed nerve roots at the source, ESIs can provide rapid, meaningful relief that allows patients to return to daily activities and engage in physical therapy more effectively.
Dr. Imran Qureshi performs epidural steroid injections using fluoroscopic (X-ray) guidance to ensure precise, accurate needle placement. This image-guided approach distinguishes interventional spine specialists from general practitioners and significantly improves both safety and efficacy.
Conditions Treated with Epidural Steroid Injections
ESIs are highly effective for nerve-related pain caused by spinal pathology. Dr. Qureshi recommends them for patients experiencing:
- Herniated or bulging discs — when disc material compresses a nearby nerve root
- Sciatica — radiating pain, numbness, or tingling running from the lower back through the buttock and down the leg
- Lumbar spinal stenosis — narrowing of the spinal canal that puts pressure on the spinal cord and nerve roots
- Cervical radiculopathy — nerve compression in the neck causing pain, weakness, or numbness into the arm
- Degenerative disc disease — age-related disc breakdown causing chronic inflammation
- Failed back surgery syndrome — persistent pain following spinal surgery
- Spondylolisthesis — slippage of one vertebra over another causing nerve irritation
How Epidural Steroid Injections Work
The mechanism is straightforward: inflammation around compressed nerve roots is the primary driver of pain in most disc and stenosis conditions. Corticosteroids are the most potent anti-inflammatory agents available, and delivering them directly to the inflamed site — rather than taking oral steroids that affect the entire body — produces a more targeted, concentrated effect with fewer systemic side effects.
The local anesthetic included in the injection provides immediate but temporary relief, allowing Dr. Qureshi to confirm the injection reached the correct location. The corticosteroid then begins to work over 3–5 days, with peak effect typically at 1–2 weeks.
The Procedure: Step by Step
The procedure takes 15–20 minutes from start to finish and is performed in our on-site fluoroscopy suite. Here is what to expect:
- Positioning: You'll lie face-down on the procedure table with a pillow under your abdomen to gently flex the spine and open the interlaminar space.
- Skin preparation: The injection site is cleaned with antiseptic solution and a small amount of local anesthetic is applied to numb the skin — this is typically the only discomfort of the procedure.
- Fluoroscopic guidance: Using real-time X-ray, Dr. Qureshi advances the needle to the epidural space and confirms positioning with contrast dye before delivering the medication.
- Injection: The steroid-anesthetic solution is injected. Most patients feel mild pressure; the process takes under 2 minutes.
- Recovery: You rest in our recovery area for 20–30 minutes while we monitor your blood pressure and response. A driver must take you home.
Important: ESIs are typically performed in a series of up to 3 injections spaced 2–4 weeks apart. Most patients require 1–2 injections to achieve meaningful relief. Dr. Qureshi will reassess your response after each injection and adjust the plan accordingly.
Benefits and Expected Results
When properly indicated and accurately placed, epidural steroid injections provide significant pain reduction in approximately 70–80% of appropriate candidates. Specific benefits include:
- Meaningful pain reduction within 1–2 weeks in most patients
- Relief duration ranging from weeks to months, sometimes longer
- Reduced need for oral pain medications, including opioids
- Ability to participate in physical therapy and rehabilitation
- Avoidance of or delay of surgical intervention in many cases
- Diagnostic value: a good response confirms the treated level is the pain generator
Am I a Candidate?
You may be a good candidate for epidural steroid injections if you have:
- Radicular (nerve-type) pain with imaging evidence of disc herniation or stenosis
- Pain that has not fully responded to 4–6 weeks of conservative treatment (physical therapy, anti-inflammatories)
- Functional limitations that prevent adequate participation in therapy
- Desire to avoid or delay surgery
ESIs are generally not recommended for patients with active spinal infection, bleeding disorders, uncontrolled diabetes (steroids transiently raise blood sugar), or documented allergy to the medication components. Dr. Qureshi will review your full medical history before recommending this treatment.
Risks and Side Effects
Epidural steroid injections performed by a trained interventional specialist using fluoroscopic guidance are very safe, with a low complication rate. Potential side effects include:
- Temporary pain flare: Some patients experience 1–2 days of increased soreness at the injection site before improvement begins
- Temporary blood sugar elevation: Diabetic patients should monitor closely for 48–72 hours
- Facial flushing or sleep disruption: Mild, transient steroid effects lasting a few days
- Headache: Rare; occurs if the dural membrane is inadvertently punctured ("wet tap")
- Infection or bleeding: Very rare with proper sterile technique