Epidural Steroid Injections for Back & Neck Pain Relief

Epidural Steroid Injections (ESIs) are a common and effective treatment used to reduce inflammation and relieve pain that radiates from the spine into the arms or legs. This occurs when spinal nerves become irritated due to narrowing of the spaces where they travel — a condition known as spinal stenosis.

Whether you're experiencing low back pain that radiates to the legs (lumbar radiculopathy) or neck pain radiating to the arms (cervical radiculopathy), ESIs may offer significant relief.

Why Consider an Epidural Steroid Injection?

Several spinal conditions can lead to nerve inflammation, including:

  • Herniated or bulging discs

  • Spinal stenosis

  • Bone spurs

  • Thickened spinal ligaments

  • Joint cysts

  • Spondylolisthesis (“slipped vertebra”)

The epidural space is a fat-filled area surrounding the spinal sac. When corticosteroid medication is injected into this space, it works to reduce inflammation, relieve pain, and improve mobility. While steroids don’t fix the underlying cause, they can interrupt the pain cycle long enough for the body to heal or adapt.

Spine anatomy with highlighted epidural space

Spine Anatomy with the Epidural Space

Spine anatomy with highlighted epidural space

How Are Epidural Injections Performed?

Epidural injections are performed under fluoroscopic (x-ray) guidance in an outpatient setting. A small amount of contrast dye confirms accurate placement before injecting the steroid.

There are two primary approaches to epidural injections:

Interlaminar Approach

The needle is inserted into the back of the epidural space to deliver steroid over a broad area. This technique allows medication to reach multiple levels and both sides of the spinal canal.

Transforaminal Approach (Nerve Root Block)

Steroid is delivered directly next to the affected nerve root. This targeted approach is especially effective when one side or one spinal segment is involved. It can also provide diagnostic insight when confirming the source of pain.

Injections are typically performed using only local anesthetic, though light sedation is available if needed. Most patients return to normal activity the next day.

Two common epidural injection techniques: interlaminar and transforaminal

  • X-ray image of an interlaminar lumbar epidural

    Interlaminar Lumbar Epidural

  • x-ray image of a lumbar transforaminal epidural

    Lumbar Transforaminal Epidural

  • x-ray image of a cervical transforaminal epidural

    Cervical Transforaminal Epidural

What to Expect After the Injection

  • Relief may begin within 1–3 days, but in some cases it may take up to a week.

  • Temporary soreness or an increase in pain for several days is not uncommon.

  • Duration of relief varies—some patients experience months of reduced pain and improved function.

ESIs are often combined with physical therapy, medications, or lifestyle changes to extend their benefit.

Potential Risks and Complications

While ESIs are generally safe when performed by experienced physicians like Dr. Jerry Sobel, there are some potential risks:

  • Infection – Rare (0.01%–0.1%)

  • Dural puncture (“wet tap”) – 0.5%; may cause spinal headache

  • Bleeding – More likely in patients with bleeding disorders or on blood thinners

  • Nerve injury – Extremely rare but possible

  • Allergic reaction – Typically to contrast dye or anesthetic

Corticosteroid Side Effects

Most side effects are temporary and mild:

  • Flushing of face or chest

  • Insomnia

  • Anxiety or mood changes

  • Headache

  • Temporary increase in pain (post-injection flare)

  • Elevated blood sugar in diabetics

  • Water retention or bloating

  • Menstrual changes

  • Heartburn or GI upset

  • Rare: Avascular necrosis of the hip

Important Pre-Procedure Instructions

  • Stop NSAIDs 3 days before your procedure.
  • Discuss other medications with your primary care doctor or cardiologist, as directed by Dr. Sobel or his staff. View the complete list on our Medications to Stop Before Procedures page.
  • Do not eat for 4–6 hours before your appointment.
  • Only small sips of clear liquids up to 2 hours prior to take medication(s).
  • A full instructions sheet will be provided at your appointment.
Is the injection painful?
Most patients report mild discomfort similar to a blood draw. Local anesthetic is used to numb the skin.
How soon will I feel relief?
Relief may begin in 1–3 days, though for some patients it may take up to a week.
Can I resume normal activities afterward?
Yes, most patients return to their usual activities by the next day unless otherwise instructed.
How many injections can I receive?
Most patients receive no more than 3 injections per year, depending on response and physician recommendation.

📍Contact Dr. Jerry Sobel

If you’re suffering from radiating back or neck pain and want to explore non-surgical options, schedule an appointment with Dr. Jerry Sobel at Sobel Spine and Sports in Phoenix, Arizona.

📞 Phone: 602-385-4160
📍 Address: 4550 E Bell Road, Suite 110, Phoenix, AZ 85032
💻 Website: www.sobelspineandsports.com