Procedure for Lumbar Epidural Steroid Injection: Steps and Precautions


The injection is usually given while the patient lies on their stomach (prone position) on a fluoroscopy (live x-ray) table. The procedure may take up to 15 minutes. The procedure selected is most commonly a transforaminal, interlaminar, facet or joint injection.

On the day of the injection procedure, instructions start with normal eating and drinking on the day of the procedure. An epidural steroid injection is an outpatient procedure. Patients may drive themselves to the procedure, but it is recommended to have someone drive the patient to the procedure if the patient is very nervous.

The patient receives a local anesthetic for anesthesia.
It is important to notify of use of blood thinners and how it was modified to prevent bruising or bleeding during the procedure.
It is important for the staff to be told if you have diabetes, any allergies or concern of pregnancy.

The common steps involved in the injection procedure are as follows:
The skin over the injection site is marked and cleaned with betadine.
A fluoroscopic x-ray is used to locate the correct vertebral level for needle guidance; the live images can be seen on a computer screen.
A local anesthetic is injected into the skin and underlying tissues to numb the area.
A spinal needle is inserted into the intended injection site and guided using fluoroscopy.
When the needle is confirmed on the proper location with fluoroscopy, the steroid medication is injected.
A tingling or mild burning sensation or the feeling of pressure may be experienced as the medication is injected. When the injection is completed, the irritation and discomfort usually disappear within a few minutes.

Strenuous physical activities, swimming in a pool and flying in an airplane are not recommended on the same day after the procedure.
While the local anesthetic in an epidural steroid injection usually provides immediate pain relief, it may take up to 2 weeks for the steroids to take effect. Regular activities may be resumed slowly on the day after the injection. Ice packs may be used at home if pain occurs at the injection site. Ice packs are usually used for 15 to 20 minutes at a time with a break of at least two hours in between to avoid skin injury.