Epidural Steroid Injections

An epidural steroid injection (ESI) is an X-ray-guided shot of anti-inflammatory steroid and numbing medicine into the space around irritated spinal nerves. It is used for pain that travels from the back into the leg (sciatica) or from the neck into the arm. Relief usually starts within days and can last weeks to months.

At Empire Minimally Invasive Spine and Pain, our interventional pain physicians perform lumbar and cervical ESIs on Long Island — in Plainview, New Hyde Park and Ronkonkoma, NY — and at our Clifton, NJ office.

What an epidural steroid injection treats

An ESI places anti-inflammatory steroid medication into the epidural space around your spinal nerves. When a nerve root is inflamed and irritated — usually by a herniated disc, spinal stenosis, or degenerative changes — that inflammation is what sends pain, numbness, or tingling down your leg or arm. The injection reduces the inflammation so the nerve can settle.

It tends to help most with radicular pain — pain that travels along a nerve path. The classic example is sciatica, where a lower-back problem sends pain down the leg. It’s generally less useful for pain that stays local to the back or neck without radiating, which is often better addressed with a facet joint injection instead.

Types of epidural steroid injections

Your physician picks the approach based on where the nerve is irritated and what your imaging shows. According to Cleveland Clinic, the three main approaches are:

• Interlaminar: the needle goes between the bony arches at the back of the spine, so the medicine spreads over the area. Often used for disc herniation and spinal stenosis.
• Transforaminal: the medicine is placed at the opening where one nerve root leaves the spine. Often used when a single nerve is the problem, such as a disc pressing on one root.
• Caudal: the injection goes in through a small opening near the tailbone. It may be used for ongoing pain after back surgery.

Lumbar vs. cervical: a lumbar ESI treats low back pain that runs into the buttock, leg or foot. A cervical ESI treats a pinched nerve in the neck that sends pain, tingling or weakness into the shoulder, arm or hand. Learn more on our neck pain doctor page.

Who is a candidate for an epidural steroid injection?

Good candidates usually have radicular pain from a herniated disc or spinal stenosis. An ESI is often worth considering when:

• Your pain radiates — down the leg (sciatica) or into the arm
• Imaging points to a herniated disc, stenosis, or an irritated nerve root that matches your symptoms
• A few weeks of rest, medicine or physical therapy hasn’t settled it
• You’d like to avoid, or at least delay, surgery and lean into rehab instead

Tell your physician if you take blood thinners, have diabetes, have an infection, or could be pregnant. These can change the timing of an injection or whether it is a good choice for you.

What to expect during an epidural steroid injection

• Before: we review your exam and imaging. Bring a list of your medicines, and only stop a blood thinner if the doctor who prescribed it says it is safe. Plan for someone to drive you home.
• During: you lie on your stomach (or as positioned for a neck injection) and stay awake. The skin is numbed, and your physician uses fluoroscopy — live X-ray — to guide the needle to the right spot before injecting the medicine. Most lumbar ESIs take 15 to 30 minutes (Cleveland Clinic).
• After: you rest briefly and go home the same day. Take it easy for the rest of the day. Soreness at the site, or a short flare of pain before it improves, can happen. Many people return to light activity the next day.

How long relief lasts and how often you can repeat it

According to Cleveland Clinic, ESIs start working within two to seven days. Relief from a lumbar ESI most often lasts three months or more, but it can be as short as a few days or as long as a year — and some people get little or no relief. For a day-by-day timeline, read how long an epidural injection takes to work for sciatica.

If an injection helps, it can be repeated later. Because frequent or high-dose steroid injections can weaken bone, most providers limit patients to two or three ESIs per year. Your physician sets the schedule based on how well each one works.

The honest way to think about it: an ESI opens a window of lower pain, and the lasting fix comes from what you do inside that window — physical therapy, strengthening, and staying active.

Risks and side effects

ESIs are usually safe, but no procedure is risk-free. Short-lived side effects can include soreness at the injection site and a brief flare of pain. If you have diabetes, ask how to watch your blood sugar for a few days afterward. Rare risks listed by Cleveland Clinic include:

• Lightheadedness from low blood pressure
• A severe headache from a spinal fluid leak
• Infection or bleeding at the injection site
• A reaction to the medicine, such as hot flashes or a rash
• Nerve injury, which in very rare cases can be permanent

Call your doctor or seek care right away if you have a severe headache that gets better when you lie down, a fever, new numbness or weakness in your legs, or loss of bladder or bowel control.

Cost and insurance

What you pay depends on your plan, the type of injection, and how many levels are treated. Some plans require prior authorization, and our team checks this for you before your visit. For a deeper look, read our guide to epidural steroid injection cost and coverage.

• New York (Plainview, New Hyde Park, Ronkonkoma): we accept most major insurance plans, including Medicare, as well as New York workers’ compensation (including federal OWCP/DOL/FECA claims) and no-fault auto insurance. Call 516-229-1443.
• New Jersey (Clifton): we accept PPO and POS plans, in-network and out-of-network, and personal injury (auto PIP) claims. Call 732-630-7246.

Epidural steroid injections on Long Island

Epidural steroid injections in Clifton, NJ

Frequently asked questions

How long does an epidural steroid injection take to work?

Most ESIs start working within two to seven days. The steroid needs time to calm the inflamed nerve, so relief builds rather than switching on at once. If you notice no change after about two weeks, let your physician know.

Does an epidural steroid injection hurt?

The skin is numbed first, and most people feel pressure more than sharp pain. Some soreness at the site for a day or two afterward is normal.

How long does an epidural steroid injection last?

It varies. Relief from a lumbar ESI most often lasts three months or more, but some people get a shorter benefit and some get little or none. Using the lower-pain window for physical therapy helps the improvement last.

How many epidural steroid injections can you have in a year?

Most providers limit patients to two or three ESIs per year, because frequent or high-dose steroid injections can weaken bone. Your physician sets the schedule based on how well each one works for you.

Does insurance cover epidural steroid injections?

Many plans do, often with prior authorization. In New York we accept most major plans, including Medicare, plus workers’ compensation and no-fault. In New Jersey (Clifton) we accept PPO and POS plans and auto PIP claims. We verify your benefits before your visit.

What if the injection doesn’t work?

Not everyone responds, which is why an ESI is one step, not the whole plan. If it doesn’t help enough, we’ll talk through other options, such as radiofrequency ablation or a fresh look at the diagnosis, rather than simply repeating it.