Sciatica, radiating pain, numbness, or tingling that travels from the lower back down the leg—is often caused by irritation of the spinal nerve roots. While many cases improve with rest, physical therapy, and medications, some patients continue to experience significant discomfort that disrupts daily life. Epidural steroid injections (ESIs) are a minimally invasive option designed to reduce inflammation around the affected nerves and provide targeted relief. Below, we outline when ESIs may be appropriate, explain the procedure steps, and highlight what you can expect before, during, and after treatment.
1. Understanding Sciatica and Epidural Steroid Injections
Sciatica occurs when a herniated disc, spinal stenosis, or other structural change compresses or irritates a lumbar nerve root. This often leads to sharp, shooting pain, muscle weakness, or sensory changes in the buttock, thigh, or lower leg. An epidural steroid injection delivers a concentrated dose of corticosteroid and local anesthetic directly into the epidural space surrounding the spinal cord and nerve roots. By targeting inflammation at its source, ESIs can interrupt pain signals and give patients a window of relief during which other therapies can take effect.
2. Indications: Who Benefits Most from ESIs
ESIs are usually considered when:
- Conservative measures have been exhausted
Patients have tried rest, NSAIDs, physical therapy, and activity modification for at least 4–6 weeks without adequate relief. - Pain is moderate to severe or limits function
Persistent pain that interferes with sleep, work, or mobility may warrant an injection. - Imaging correlates with symptoms
MRI or CT scans show disc herniation, foraminal narrowing, or other nerve-irritating changes at the symptomatic level. - Patient prefers to avoid or delay surgery
Many individuals use ESIs to postpone or eliminate the need for operative intervention when possible.
3. The Injection Procedure: What to Expect
- Preparation: You’ll lie face-down on the procedure table. The skin over your lower back is cleaned and numbed with local anesthetic.
- Imaging Guidance: Under fluoroscopic (X-ray) or ultrasound guidance, a thin spinal needle is advanced into the epidural space. Contrast dye may be injected briefly to confirm correct placement.
- Medication Delivery: A mixture of corticosteroid and anesthetic is injected around the irritated nerve root.
- Duration: The entire visit typically takes 15–30 minutes. You’ll rest for up to 30 minutes afterward to monitor for any immediate reaction.
4. Expected Outcomes and Follow-Up
- Onset of Relief: Some patients feel noticeable pain reduction within 24–72 hours, while others may require up to two weeks to experience full benefit.
- Duration: Relief can last from several weeks to several months. In many cases, a single injection provides sufficient pain control; others may benefit from a series of two or three injections spaced several weeks apart.
- Adjunct Therapies: During the relief window, it’s ideal to engage in guided physical therapy, core-strengthening exercises, and ergonomic adjustments to address underlying causes and reinforce long-term improvement.
5. Risks, Considerations, and Contraindications
While ESIs are generally safe, potential risks include temporary headache, increased blood sugar (particularly in diabetics), local discomfort, or, rarely, infection or bleeding. They are not recommended for patients with uncontrolled infections, certain bleeding disorders, or allergies to contrast dye or steroid medications. Your provider will review your medical history and imaging to ensure ESIs are appropriate and safe for you.
Epidural steroid injections can offer meaningful relief for patients with persistent sciatica who have not achieved adequate improvement with conservative care. If your leg pain continues to limit your activities or sleep, schedule a consultation with Florida Joint & Spine Institute. Our specialists will evaluate your condition, review your imaging, and help determine whether ESIs—or another tailored treatment plan—are right for you.