spinal nerve roots are
surrounded by a sac, the
dural sac. The epidural
space is the space
located outside the dural
sac. The epidural space is
filled with fat and small
blood vessels. The
spinal nerves traverse
the epidural space to exit
the spine. An epidural
steroid injection is the
placement of a powerful
anti-inflammatory agent
into the epidural space
which surrounds the spinal
Our epidural steroid injections are performed in one of two state of
the art fluoroscopy suites. You will be positioned on a special X-ray
table. Your skin will be sterilized. The site of injection will be
located with the use of an X-ray machine. Local anesthesia will be
injected at the skin to numb ("deaden") the site. Using the X-ray
equipment, a small needle will be guided to the area of injection in
the epidural space. A special type of dye may be used to determine
how the medication will spread, and then the steroid will be injected
with a small amount of sterile saline. The needle will then be
withdrawn. Your nurse will assist you back to your examination
room, and after a brief observation period you will be discharged.
The success rates from epidural steroid injections vary greatly among patients. Some trials
report success rates ranging from 25-89%. Obviously, there is a great deal of variability
among patients and spinal disorders. Best results are obtained in more acute cases but even
patients with long-standing symptoms have received benefit from epidural steroid injections.
Each patient is evaluated on an individual basis. An initial, short-lasting beneficial response
can be expected from the injection of a local anesthetic. The steroid response “kicks-in” after
several days, but lasts much longer.
Radiculopathies (disorders affecting one of the nerve roots that arise from the spinal cord) of
six-month duration or less have an overall response rate to epidural steroid injection of 60-
70%. Patients who present with pain of over a year duration have a response rate of 40-50%.
The few studies available looking at long term results show a recurrence of pain in 50% of
responders after twelve months. The etiology of the lesion may have a role to play in this.
Pain related to a herniated disk or disk bulge often responds well while pain related to
structural lesions such as spondylolysis, spondylolisthesis, scoliosis or spinal stenosis have
poorer response rates. This may be due to nerve fibrosis secondary to prolonged or recurrent
inflammation of many years duration. Even in cases of spinal stenosis if an acute
radiculopathy develops it may be treated as if it were a new lesion, often with good response
rates. Recurrence of pain postlaminectomy may be treated in a similar fashion. Radicular pain
in a new distribution or pain recurring after a significant period of relief may be amenable to
epidural steroids. Postlaminectomy pain related to scarring around nerve roots or facet joints
may benefit from alternate approaches such as facet joint nerve blocks or lysis of adhesions.
Epidural steroid injections are also effective for other diagnoses. Recovery is often hastened in
patients who have suffered an annular tear (lumbar sprain).
The beneficial effect of a series of three consecutive injections may last as little as a few
weeks, to many months. In many non-surgical cases a permanent degree of pain alleviation
can be achieved with improvement in functional state.
Studies have demonstrated that patients who did not respond to an initial injection did still
show improvement after 1 or 2 more epidural steroid injections.
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