FAQs on Epidural Steroid Injections in Atlanta


An epidural steroid injection (ESI) is a combination of a potent corticosteroid along with a local anesthetic agent, such as lidocaine. Liquid corticosteroid medicines relieve swelling and inflammation, which takes the pressure off soft tissues and nerves to relieve pain. The anesthetic numbs the area to provide immediate pain relief.

Where is the epidural steroid injected?

The epidural space surrounds the spinal cord and nerve roots, and it lies within the spinal canal. By injecting a steroid medication into this area, pressure is reduced from the spinal nerve roots.

Why is the epidural steroid injection used?

ESI is used when other conservative, nonsurgical treatments fail to relieve the pain associated with certain conditions, such as lumbar spinal stenosis, herniated disc, bulging disc, and degenerative disc disease. The lidocaine is injected to relieve pain quickly, whereas the corticosteroid provides pain relief long-term.

What can I expect before the ESI?

Before considering an epidural steroid injection, the doctor will order imaging tests, such as a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan. These tests are used to help the Atlanta pain management doctor locate the exact area where the nerve roots are been compressed. When you arrive at the medical center for the ESI, a nurse will start an intravenous (IV) catheter in your arm, to give you a sedative if it is required.

How is the epidural steroid injection done?

The doctor will use an x-ray machine (fluoroscope) to guide the needle, which is placed through the skin and soft tissues of the back and into the epidural space. There are three approaches used for the ESI. These include:

  • Interlaminar ESI – The needle(s) is/are placed into the back portion of the epidural space, so the steroid can be delivered over a wider area. The medication spreads to both sides of the spinal canal, reaching many segments.
  • Caudal ESI – The needle(s) is/are positioned at the sacral hiatus, which is the boney opening above the tailbone (coccyx) located at the bottom of the epidural space.
  • Transforaminal ESI – When injected by transforaminal method, it is called a “nerve block.” This involves positioning the needle(s) along the nerve as it leaves the spinal cord. The corticosteroid is placed into the nerve sleeve, so it travels up the sleeve to the epidural space. This method assures that the steroid enters just one side or segment, which is more specific for the coverage of a single nerve.

What can I expect after the ESI?

The corticosteroid starts to work within 3 days, but it can take up to a week for maximum effects. Most patients tolerate the medication well, but it is not unusual to feel a warmth of the chest and face (called the steroid flush) during the injection and a few days afterwards.

How long will I stay at the office or hospital?

All epidural steroid injections are done on an outpatient basis, which means you can return to your normal level of activity the following day. If you receive sedative medication for the procedure, be sure to bring someone to drive you home.

What are the side effects of the ESI?

All medications have side effects, but this doesn’t mean that you will experience all or even one of them. Side effects to corticosteroids include trouble sleeping, anxiety, and temporary water retention.

How well does the epidural steroid injection work?

The ESI is a safe and effective procedure, which can be repeated periodically to maintain benefits and relieve pain. When used as an adjunctive therapy along with physical therapy and oral medications,

ESI are well-tolerated. Numerous clinical studies show a success rate of 80-90% with ESI. Patients who have symptoms for less than 3 months usually have a better response rate.