Patient guide · Gabriel Radu, DO · Physical Medicine & Rehabilitation · Pain Management

Lumbar epidural steroid injection

Name: Lumbar Epidural Steroid Injection: A Patient Guide | Radu Physiatry
Creator: Gabriel Radu, DO

For sciatica, the pain, tingling, or numbness that runs down a leg from an irritated nerve in the low back. Anti-inflammatory medicine is placed right next to the inflamed nerve to calm it, so you can move and do therapy while it heals.

About 1 hourVisit from check-in to home
2–14 daysFor the steroid to take full effect
X-ray guidedWith contrast dye to confirm placement
A bridgeTo therapy and recovery, not a cure

All procedures The 8 guides

Why an epidural injection can help

When a disc bulges or herniates, or the spinal canal narrows (spinal stenosis), a nerve root in the low back can become squeezed and inflamed. That causes sciatica: pain, tingling, or numbness that runs from the back or buttock down the leg.

An epidural steroid injection places an anti-inflammatory steroid, usually with a numbing medicine, into the epidural space, the fat-filled space around the sac of nerves. The goal is to calm the inflamed nerve so pain eases enough for you to move, sleep, and do physical therapy while the problem heals. Most disc-related sciatica improves over weeks to months, and the injection is meant to help you through that time. It does not repair the disc or widen the canal.

An injection can also help with diagnosis. If numbing one specific nerve root relieves your leg pain, that nerve is likely the source.

Your low back, and where the medicine goes

3D side-view cutaway of the lower lumbar spine showing a needle from the back reaching the epidural space, with blue medicine spreading behind the dural sac — Side view of the lower spine, cut down the middle. With the **interlaminar** approach, the needle passes between two vertebrae at the back and the medicine (blue) spreads in the epidural space behind the sac of nerves.

3D top-down cross-section of a lumbar vertebra showing a needle approaching from the side and medicine around the exiting nerve root — Top-down slice through a lumbar vertebra. With the **transforaminal** approach, the needle is angled from the side so medicine (blue) collects right around the irritated nerve root as it leaves the spine.

The three approaches

Approach	Where the needle goes	Often chosen when
Transforaminal	Beside the nerve root, where it leaves the spine	One nerve root on one side is the clear problem
Interlaminar	Between two vertebrae at the back, near the middle	Pain on both sides, or several levels are involved
Caudal	Through a small natural opening at the base of the spine near the tailbone	Previous back surgery, or the lowest levels are involved

Your physician chooses the approach based on your symptoms, exam, and imaging.

Preparing

At least a week before, give your team a full list of medicines, vitamins, and supplements.
If you take a blood thinner or anti-platelet medicine, do not stop it on your own. Your prescribing doctor and procedure team will decide together.
Tell us if you are pregnant or might be, have diabetes, have an infection, or are allergic to contrast dye, iodine, latex, local anesthetic, or steroids.
Follow any eating and drinking instructions, and arrange an adult to drive you home.
Bring any outside X-ray, CT, or MRI reports.

Procedure day

Check-in
Consent form, pain rating, and a brief exam. An IV is sometimes placed.
Positioning
You lie on your stomach on an X-ray table. Your heart rate and oxygen may be monitored.
Numbing and guidance
The skin is cleaned and numbed. Using live X-ray, the physician guides the needle and injects a small amount of contrast dye to confirm the medicine will spread in the right place.
Medicine
A steroid, often with a numbing medicine, is injected slowly. You may feel pressure, or a brief familiar ache in your leg.
Home
You rest for 15–30 minutes, then go home with a driver. The whole visit usually takes about an hour.

Afterward

Your leg may feel numb or heavy for a few hours from the numbing medicine. Walk with support until it wears off.
Soreness at the injection site for a day or two is normal. Use ice, 15–20 minutes at a time.
The steroid usually starts working in 2–4 days and can take up to 2 weeks for its full effect. Pain may be a little worse before it improves.
Walk the same day if you feel up to it. Avoid strenuous activity for 24 hours, then return to normal activity.
If you have diabetes, check your blood sugar more often for several days.
Start or resume physical therapy and your home exercises once the pain eases. That is what makes the improvement last.

Pain log

Bring this to your follow-up visit. It helps decide whether another injection, a different approach, or something else makes sense.

When	Main pain 0–10	Arm or leg pain 0–10	Notes (walking, sleep, medicines)
Before
1 hour
Day 1
Day 3
Week 1
Week 2
Week 4
Week 6

What the research shows

54%vs 7–21%

Transforaminal steroid for sciatica

In a blinded trial, 54% of patients given a transforaminal steroid injection had at least 50% leg-pain relief at 1 month, compared with 7–21% after numbing medicine alone, saltwater, or a steroid shot into the muscle. Fewer patients kept their relief over the following year.

Ghahreman 2010^[1]

Short-termbenefit

Review of 30 placebo-controlled trials

For nerve-root pain, epidural steroids reduced pain and improved function in the short term, and lowered the short-term chance of surgery. The average benefit was modest and did not last in the long term.

Chou 2015^[2]

Littleextra benefit

Spinal stenosis (LESS trial)

In 400 older adults with spinal stenosis, adding a steroid to numbing medicine gave minimal or no extra benefit at 6 weeks.

Friedly 2014^[3]

The honest summary: epidural steroids work best for leg pain from an inflamed nerve root, especially from a disc herniation. Relief is often temporary, which is why they are used as a bridge to recovery and therapy. They help less for stenosis and for back pain alone. Many insurers limit how many injections you can have in a year.

Risks

Serious problems are rare. Possible side effects and risks include:

Temporary increase in pain for a day or two
Headache. A "spinal headache" that is worse sitting up and better lying flat can happen if the covering of the spinal fluid is punctured.
Facial flushing, trouble sleeping, mood changes, or a temporary rise in blood sugar from the steroid
Bleeding or infection (rare)
Allergic reaction
Nerve injury, very rarely leading to lasting weakness or paralysis

How we keep you safe

In 2014 the FDA required steroid labels to warn about rare but serious neurologic events after epidural injection.^[5] A national working group convened with the FDA then issued safety steps that physicians follow, including live X-ray guidance with contrast dye, test doses, and using a non-particulate steroid (such as dexamethasone) for certain approaches.^[4]

Call your care team right away if you have

Fever of 100.4°F (38°C) or higher
Redness, swelling, or drainage at the injection site
A severe headache, especially one that is worse sitting or standing
New or worsening leg weakness or numbness
New loss of bladder or bowel control, or numbness in the groin. Go to the emergency room.

Questions to bring

Which approach will you use, and why?
Which nerve root do you think is involved?
How many injections might I need, and how far apart?
When should I start or restart physical therapy?
If this doesn’t help, what are the next options?

References

Ghahreman A, Ferch R, Bogduk N. The efficacy of transforaminal injection of steroids for the treatment of lumbar radicular pain. Pain Medicine. 2010;11:1149-1168. doi.org/10.1111/j.1526-4637.2010.00908.x
Chou R, et al. Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis. Annals of Internal Medicine. 2015;163:373-381. doi.org/10.7326/M15-0934
Friedly JL, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. New England Journal of Medicine. 2014;371:11-21. doi.org/10.1056/NEJMoa1313265
Rathmell JP, et al. Safeguards to prevent neurologic complications after epidural steroid injections: consensus opinions from a multidisciplinary working group and national organizations. Anesthesiology. 2015;122:974-984. doi.org/10.1097/ALN.0000000000000614
U.S. Food and Drug Administration. Drug Safety Communication: FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain. 2014. www.fda.gov/Drugs/DrugSafety/ucm394280.htm

About this page. This guide is general education written for patients. It does not replace advice from your own doctor, and results differ from person to person. Numbers quoted come from the published studies listed in the references; many large device studies are funded by the companies that make the devices, which we note where it applies.

Brand names that appear here are trademarks of their owners. This page is independent: it was not produced, paid for, or reviewed by any device manufacturer.

3D illustrations were rendered for this site from the open anatomy models of Z-Anatomy and BodyParts3D (© The Database Center for Life Science, CC BY-SA 2.1 JP; Z-Anatomy, CC BY-SA 4.0). Device hardware is a generic representation, not any specific product. The illustrations are shared under CC BY-SA 4.0.

Last reviewed: September 2026. If you have urgent symptoms, call your care team or 911.