Overview
Epidural steroid injections (ESIs) are among the most commonly performed and well-studied procedures in interventional pain medicine. They deliver a corticosteroid (anti-inflammatory medication) directly into the epidural space — the area surrounding the spinal cord and nerve roots — to reduce inflammation, decrease nerve irritation, and provide meaningful, sustained pain relief. Dr. Migdale performs ESIs under fluoroscopic (X-ray) or ultrasound guidance to ensure precise needle placement at the exact level and side of nerve involvement.
How Epidural Steroid Injections Work
Nerve pain from disc herniations, spinal stenosis, and radiculopathy is driven in large part by inflammation. When a disc presses on a nerve root, it triggers a chemical inflammatory cascade that amplifies pain signals. Corticosteroids are among the most potent anti-inflammatory agents available — and delivering them directly into the epidural space at the affected level achieves a much higher local concentration, and much faster effect, than oral steroids could provide.
Types of Epidural Steroid Injections
Dr. Migdale performs three approaches depending on anatomy and diagnosis: the transforaminal approach (at the nerve root foramen — the most targeted, delivering medication directly at the inflamed nerve root); the interlaminar approach (midline, covering a broader area); and the caudal approach (through the sacral hiatus, useful for lower lumbar and sacral levels). The transforaminal approach is generally preferred for disc herniations causing radiculopathy because it places medication precisely at the affected nerve.
What to Expect
The procedure is performed in an outpatient or ambulatory surgery center setting. You will lie on a fluoroscopy table; the skin is cleaned and local anesthetic applied. Under continuous X-ray guidance, the needle is precisely positioned and contrast dye confirms correct placement before medication is injected. The procedure typically takes 15–30 minutes. Most patients can return home the same day. Relief typically begins within 2–7 days and may last weeks to several months.