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Epidural Steroid Injections for Neck, Arm, Back & Leg Pain

Physiotherapist doing healing treatment on a male patient's back.SPINAL CORD, ITS BRANCHING NERVES, and spinal fluid travel through the spinal canal.  All are encased within a thin membrane known as the dura. Even though this dural membrane somewhat protects the spinal cord and nerves, spine disorders can compress and irritate these structures which leads to pain plus extremity numbness and weakness. The most common spine disorders are herniated discs, slipped discs, spinal stenosis, and bone spurs of the spine. When a spinal nerve becomes pinched by a disc disorders, irritation and inflammation occurs which results in pain, numbness, and weakness wherever the nerve travels.  This radiating discomfort is  known as radiculopathy in the arms or legs.  It is termed sciatica if the symptoms travel down the back of the legs and into the calves or foot. Fortunately, most cases of pain from a pinched or inflamed nerve are mild to moderate and resolve quickly. For some patients, however, pain can be quite disabling or does not improve within a reasonable amount of time despite physical therapy and NSAIDS. For these patients, an epidural injection can provide adequate pain relief so they can return to normal functioning. Steroids can reduce inflammation and the resulting pain very effectively. When taken in pill form, only a small amount is delivered to the target area, while the rest is absorbed into the body. This can cause side effects such as increase glucose levels in the blood.  When steroids are delivered to the target area by injection, a greater, longer-lasting effect can be achieved while reducing exposure to the entire body.  In the case of neck or back pain caused by irritation to the nerve roots or spinal cord steroids injected into the epidural space can eliminate the inflammation, thus resolving the back pain.  This procedure is performed by the pain management doctors at Centers for Neurosurgery, Spine, and Orthopedics.

Benefits of Epidural Steroid Injections

Any patient with severe pain caused by a pinched nerve in the spine can obtain relief with an epidural steroid injection. However, certain conditions must be met in order to maximize safety. If the space occupied by the nerve is too tight, injecting a volume of medication into the space may not spread into the tight space. Spinal stenosis often has this problem.  Such cases may require a transforaminal injection and if not resolved, may require surgery to open up the tight space. Similarly, if the nerve or spinal cord appears to be severely affected and is causing muscle weakness, surgery may be the best option to resolve the impending weakness and potential permanent loss of movement. Overall, surgical cases are rare.  At CNSO, only 10% of the patients that seek treatment, require surgery.  Most have resolution with physical therapy or a pain management procedure. The most common regions for epidural steroid injections are in the cervical spine (neck) and lumbar spine (low back).

How Are Epidural Steroid Injections Performed?

Injections are performed in a sterile procedure room by passing a needle through the skin and muscle overlying the spine. The exact target area is located using real-time x-ray guidance, known as fluoroscopy. Sometimes, the needle is placed in the midline (intralaminar approach) and if referred to as an epidural procedure. In other instances, the needle is placed just off the midline of the spine (1 cm) and on the same side as the problematic symptoms (transforaminal approach). The patient’s pain (unilateral or bilateral) and MRI findings determine which approach would be the most effective.

How Often Can Epidural Steroid Injections Be Performed?

Typically, epidural steroid injections are performed in sets of three or four, spaced one or two weeks apart. It is not advisable to have more than two sets of injections per year.

Not everyone responds to an epidural steroid injection. If the first injection has no effect, there is no value in repeating it.  Thus, a different diagnosis or type of treatment should be considered. Conversely, if the first injection provides complete relief, repeat injections will only be necessary if the symptoms return.

For most patients, the first injection may provide partial but noticeable relief. In such cases, it is reasonable to undergo a repeat injection within the next week or two in order to obtain additional benefits.

Possible Side Effects of Epidural Steroid Injections

In general, epidural spinal injections are routinely performed and are very safe. Rarely do complications occur.  The CNSO pain management doctor will provide an informed consent to each patient, listing possible side effects or complications and putting into perspective how likely or unlikely either are.

Risks, albeit unlikely include infection, bleeding, allergic reaction to the medication, nerve damage, and spinal fluid leak. Fortunately, when these rare events occur, they can be resolved rapidly and effectively by the CNSO multispecialty doctors.

Potential Risks and Contraindications for Epidural Injections

Epidural steroid injections should be avoided in the presence of a systemic infection or infection at the site of the skin where the needle will be inserted. Patients on blood thinners, such as Coumadin or Plavix, have an increased risk of dangerous bleeding from epidural steroid injection. These medications are usually stopped 7-10 days before the procedure, as directed by the prescribing physician.

Pregnant women should avoid these injections because of radiation exposure.

Preparing to Receive an Epidural Steroid Injection

Prior to receiving an epidural steroid injection, it’s important the physician is aware of the following:

  • Use of blood thinners such as Coumadin, Plavix, Xarelto, or Eliquis, as they can cause excessive bleeding.
  • Allergies to shellfish or contrast dye. Certain medications may be needed to prevent allergic reactions.
  • Pregnancy or the chance of pregnancy.
  • Infections or antibiotic use.

Additionally, eating or drinking should be avoided 6-8 hours before the procedure. Medications may be taken with a sip of water.

Pain Relief and Recovery After an Epidural Steroid Injection

Pain relief may be experienced for the first few hours after the procedure due to the local anesthetic effect. The pain may return to pre-injection level once the local anesthetic wears off. It usually takes 3-5 days to notice improvement, but some people may experience improvement before or after this time period. Patients are not able to return to work after the procedure, but most people do return to work the next day.

After returning home:

  • Rest and relax.
  • Apply ice packs on for 15 minutes at a time, and repeat every 2-3 hours for the first 24 hours to relieve discomfort at the injection site.
  • Apply heating pad if pain persists after 24 hours.
  • Take pain medication if necessary.

Combining Epidural Steroid Injection With Physical Therapy

Medically based research has suggested that when physical therapy is combined with an injection treatment in herniated discs it can improve the quality of pain relief and overall satisfaction in the patient more expediently. Thus, the CNSO pain management doctor may suggest a guided physical therapy program be combined with the epidural steroid injection or transforaminal treatment for an added benefit.

Centers for Neurosurgery, Spine, and Orthopedics Provides Pain-Relieving Treatment Options

Centers for Neurosurgery, Spine, and Orthopedics is a comprehensive resource for pain management treatment of any type of nerve or musculoskeletal disorder. Whether individuals are afflicted with pain from a headache, work-related back injury, motor vehicle accident, or a chronic pain disorder, top neurosurgeons, and orthopedic spine surgeons, plus non-surgical pain management doctors, physiatrists, and physical therapists of CNSO, collectively evaluate each case and provide the best, least invasive treatment. Offering multiple office locations spanning Hudson County to Morris County and the surrounding towns within such as Paramus, Kinnelon, and Hackensack,  patients interested in treatment within New Jersey are welcome to contact Centers for Neurosurgery, Spine, and Orthopedics today for effective spine pain relief.


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In order to provide an accurate diagnosis with the most effective treatment option for “back problems” and brain tumors, CNSO is led by neurosurgeons and orthopedic spine surgeons. Under the care of our award-winning neurosurgeons and orthopedic spine surgeons, Northern NJ patients can have the confidence that their medical condition will be handled with consideration for their comfort and long-term well-being as well as technical excellence.

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