Epidural Steroid Injections: An Introduction

Epidural steroid injections are the most common injections we do. The trick is knowing which patients are most likely to benefit from them.

Epidural steroid injections are one of the most common forms of pain management therapy. The procedure involves placing a needle between the bones of the spine into a potential space just outside of the dura matter, near the site generating the pain signals. A small amount of steroid medication is then injected with the goal of decreasing inflammation.


Injections can be done in any part of the spine, but injections in the lumbar and cervical regions are the most common. In addition there are several ways of accessing the epidural space, via the interlaminar spaces in or near the midline, via the neural foramina (transforaminal injections) which come in from the side and via the caudal canal which is just above the tail-bone. Each approach has its pros and cons and the correct choice depends on the history, physical findings and condition being treated. There are also a number of different medications which can be injected and once again and accurate diagnosis as well as the goals of treatment will help to determine which is most appropriate.


Epidural steroid injections are most effective for radicular pain involving either the upper or lower extremities (pain running from the spine down an arm or a leg). They are also indicated for axial back pain or axial neck pain (pain which is for the most part confined to the spine) when the cause is felt to be spinal cord or nerve root irritation.


While epidural steroid injections are one of the most common therapeutic endeavors that we employ for chronic pain, we understand that they are not indicated or appropriate for everyone. When back pain is caused by arthritis or scarring, injections in the epidural space are not likely to be effective, but injections in other areas or other forms of therapy may be. This again underscores the importance of making an accurate diagnosis before beginning treatment.

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