Oct 4, 2008

Sciatica and Epidural Injections - The Procedure


This is the final installment in this series on sciatica and epidural injections. So far we've discussed what epidural steroid injections are, what they're not, how to tell if you're a candidate, the possible risks and side effects, and finally today we're going to look at the procedure itself.

Epidural injections are a fairly simple procedure and can be performed by almost any physician, although your family doctor will probably refer you to a specialist. Orthopedic surgeons, neurologists, or anesthesiologists are normally the ones providing this service.

Choosing a Physician

Beyond the normal things you would look for in a physician, you want to be sure to ask if they use something called guided fluoroscopy. Fluoroscopy is a live x-ray procedure that allows the doctor to guide the needle into a precise location. Once the needle is correctly placed in the epidural space, a contrast material can be injected so that the doctor can see if the medication will completely reach the nerves and adjust things if necessary.

Without guided fluoroscopy, the chance for failure is greatly increased. If the needle is simply inserted blindly, the medication may not get injected into the right spot. If the medication does not reach its intended target, the entire procedure will be for naught.

You want your results to be successful, so be sure to ask about this ahead of time.

The Big Day

On the day of the procedure you will be asked to rest and avoid strenuous activities. In addition, they may ask that you refrain from eating or drinking for several hours prior to your appointment. This is mainly for cases where sedation is required.

Also, be sure to ask your doctor about any pain medications you're currently taking. They may not want you on anything that could cause complications during the procedure.

Allow yourself plenty of time. The actual injections only take about 30 minutes but you should plan on setting aside a full two hours because there is always some waiting prior to getting in and up to about 45 minutes of recovery time after the procedure.

The Preliminary Steps

First, your physician may have the nurse start an IV so that medication can be administered if needed. Usually this would be something to help you relax.

Next, they have you lie face down on the table with a pillow or similar support under your midsection to slightly curve your back. If this position is painful for you, they may have you lie on your side or sit upright.

Once you're positioned comfortably, your lower back will be cleaned and a local anesthetic will be administered to numb the area.

When you're ready to go, the doctor will insert the needle and direct it to the correct location using the guided fluoroscopy mentioned above. You may feel some pressure during this part of the procedure, but it is usually not painful.

Next the contrast dye will be injected to make sure that the steroid solution will reach the desired target.

If the needle is in the correct position, the steroid will be injected along with an anesthetic to help numb the area. Again, you may feel some pressure as the epidural is injected, but this is usually not painful.

At this point, they will monitor you for about 45 minutes to make sure there are no complications and then send you home.

What to Expect After the Injections

You will probably need to rest for the remainder of the day. By the following day, you should be able to resume normal activities. In addition, you may be a little sore around the injection site once the numbing medication wears off, but this is usually tolerable for most people.

Some people experience a temporary increase in pain after an epidural injection. This can be caused by irritation from the medications or simply because of the increased pressure in the region due to the shear amount of liquid they inject into your back. This pain usually resolves within few days.

If you do experience any complications following the procedure, be sure to contact your physician for specific instructions concerning what to do.

Wrapping Things Up

I want to repeat what I said at the beginning of this series. I am not advocating for this procedure as strongly as it may seem. I'm not suggesting that you get the injections at all. That decision is entirely between you and your doctor.

What I am trying to do is provide you with accurate information about epidural steroid injections so you can make an informed choice.

This is an extraordinary measure. It is not something that I would undertake lightly. There are always risks and potential side effects anytime you undergo a medical procedure, and these injections are no different.

Epidural steroid injections are not a cure-all. They are merely an option that some people may want to consider. They may be able to provide you with a temporary window of opportunity to proceed with a good physical therapy program.

Don't make the mistake that some people make of assuming that epidural injections are going to solve all your back problems. That is not their purpose, and you will just wind up disappointed.

I'm going to make this the final post in this series, but that doesn't mean we've covered everything. I already have a supplemental article in the works that I think you will find interesting. So stay tuned.

Next: Supplemental Article: Sciatica and the Saline Story


Table of Contents for this series:

  1. Epidural Steroid Injections
  2. Are You a Candidate?
  3. The Difference Between Corticosteroids and Anabolic Steroids
  4. Risks and Side Effects
  5. The Procedure

Supplemental Article: Sciatica and the Saline Story

About the Author

Dean Moyer is the author of the books, Rebuild Your Back, Rebuild Your Neck and The Pain Relief Manual. Copies of his books are available exclusively through this website. Read more...

Rebuild Your Back
Rebuild Your Back
Second Edition
Rebuild Your Neck
Rebuild Your Neck
The Pain Relief Manual
The Pain Relief Manual


1. Singh V, Manchikanti L. Role of caudal epidural injections in the management of chronic low back pain. Pain Physician 2002;5: 133-48.

2. Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St-Pierre A, et al. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 1997;336: 1634-40.

3. Koes BW, Scholten RJ, Mens JM, Bouter LM. Efficacy of epidural steroid injections for low back pain and sciatica: a systematic review of randomized clinical trials. Pain 1995;63: 279-88.

4. Watts RW, Silagy CA. Meta-analysis and the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesthesia Intens Care 1995;223: 564-9.

Last updated: Feb 10, 2009