Selecting Candidates for Epidural Steroid Injection
Best candidates have subacute radicular pain matching imaging findings.
- 4–12 wk: Ideal symptom window (subacute radiculopathy)
- Required: Imaging correlation (MRI-confirmed nerve root compression)
- Leg > back pain: Response predictor (radicular dominance)
- Active infection: Contraindication (local or systemic)
Selection criteria overview
Short placeholder: matches symptoms, duration, and imaging findings.
Fluoroscopy-Guided Needle Placement
Live imaging confirms accurate needle entry into the epidural space.
- Transforaminal: Approach (or interlaminar route)
- Epidurogram: Contrast check (confirms spread pattern)
- Fluoroscopy: Guidance modality (real-time C-arm imaging)
- Epidural space: Needle target (adjacent to nerve root)
Needle guidance steps
Short placeholder: contrast confirms correct epidural needle position.
Corticosteroid Delivery into the Epidural Space
Steroid solution spreads around the inflamed, compressed nerve root.
- Triamcinolone: Typical agent (or methylprednisolone)
- 1–3 mL: Volume injected (plus local anesthetic)
- Perineural: Spread pattern (around affected root)
- Days: Onset window (to early effect)
Delivery mechanics
Short placeholder: solution bathes root, reducing local inflammation.
Onset of Anti-Inflammatory Effect
Corticosteroid reduces nerve root swelling and ectopic firing.
- Cytokine suppression: Mechanism (reduces local inflammation)
- 2–7 days: Onset (variable by patient)
- ~2–3 weeks: Peak effect (after injection)
- Improves: Nerve conduction (as edema resolves)
Anti-inflammatory pathway
Short placeholder: swelling drops, root irritation gradually eases.
Expected Duration of Pain Relief
Relief typically lasts weeks to months, varying by patient factors.
- 6–12 wk: Median relief (short-to-moderate term)
- Up to 3/yr: Repeat injections (if response fades)
- Uncommon: Long-term cure (adjunct to other care)
- Acute cases: Best responders (shorter symptom duration)
Relief timeline
Short placeholder: duration depends on severity and chronicity.
Short placeholder: repeat injection considered if relief fades early.