Epidural Steroid Injection Statistics (2026): Success Rates, Volume, and Safety Data

Epidural steroid injections are one of the most common procedures in spine care, with an estimated 9 million performed each year in the United States. Reported success rates range from 18% to 90% depending on the diagnosis and technique, and serious complications are rare when the injection is done with image guidance. Here is what the 2026 data says about how well epidural steroid injections work, how often they are used, and how safe they are.

What's in This Guide

01 How Common Epidural Steroid Injections Are

Epidural steroid injections (ESIs) deliver anti-inflammatory medication into the epidural space around irritated spinal nerves. They are a mainstay of interventional pain care, and the sheer volume reflects that.

The roughly 9 million figure, cited in FDA Safe Use Initiative work and peer-reviewed safety reviews, underscores how routine these injections have become for lumbar and cervical radiculopathy. Yet utilization in the traditional Medicare population has fallen. CMS data analyzed in Pain Physician show epidural procedure rates down about 13% from 2019 to 2024, with treatment episodes down 22.6%, attributed to pandemic disruption, coverage policy changes, and economic factors rather than reduced patient need.

For a Phoenix practice serving many out-of-network and personal-injury patients, the takeaway is practical: these are well-established procedures with a long track record, and access to a physician who performs them with proper image guidance matters more than the raw utilization trend.

Source: Safety of ESIs (PMC, FDA Safe Use data) | Pain Physician, 2025 (CMS data)

02 Success Rates by Diagnosis and Approach

There is no single "success rate" for epidural steroid injections, because outcomes depend heavily on what is being treated and how the injection is delivered.

The wide 18% to 90% range reported in the literature reflects differences in diagnosis, technique, and outcome definitions. When studies isolate the right candidates, the picture sharpens. For radicular pain from a herniated disc, transforaminal injections consistently outperform other approaches: one controlled comparison found an 84% success rate for transforaminal injection versus 48% for saline. In a systematic review, herniated-disc (HNP) patients had the greatest rate of clinically meaningful improvement and 12-month success rates of 47% to 60%, higher than patients with spinal stenosis or degenerative disc disease.

This variability is exactly why diagnosis-first care matters. An injection is not a generic fix; it is a targeted tool that works best when matched to the specific pain generator. Choosing the right approach, interlaminar, transforaminal, or caudal, and confirming the right level is what separates a helpful procedure from a wasted one.

Source: Medscape / Botwin cohort data | ScienceDirect systematic review, 2022

03 How Long Relief Lasts

Duration of relief is one of the most common patient questions, and the honest answer is that it varies, but the data offers useful benchmarks.

A CMS coverage review summarizing long-term trials found that 72% to 73% of patients receiving epidural injections with local anesthetic, with or without corticosteroid, reported significant pain relief at 24 months. Other studies document relief at the three, six, and twelve-month marks, with caudal ESIs using an in-dwelling catheter showing moderate-quality evidence of effectiveness for disc herniation with radicular pain across all three windows. Some patients maintain relief for up to two years when injections are appropriately spaced.

Source: CMS LCD L36920, Epidural Steroid Injections

04 Safety and Complication Rates

Given how many injections are performed, safety is a fair question. The data consistently shows that serious complications are rare when procedures follow modern image-guided standards.

A large national database study of cervical transforaminal ESIs, among the most technically demanding, found major complications were uncommon: stroke risk of 0.46% and spinal cord injury risk of 0.08%. A prospective study of 10,261 fluoroscopically guided epidural procedures reported no major complications, with minor events including a 0.5% dural puncture rate and a 0.05% post-puncture headache rate. The FDA has cataloged rare serious neurological events, most tied to particulate steroids and cervical transforaminal technique, which is why current guidance calls for image guidance, contrast confirmation, and non-particulate steroids for cervical injections.

The practical implication: who performs the injection, and how, matters as much as the procedure itself. A surgeon who is both a spine specialist and a neurosurgeon brings a deep understanding of the relevant anatomy to procedures where needle placement precision is everything.

Source: Complication rates after CTFESI (PMC, 2025) | CMS LCD L39054

05 Where Injections Fit in Spine Care

Epidural steroid injections sit in the middle of the least-invasive-first ladder, above conservative care and below surgery, and often serve as both treatment and diagnostic tool.

Coverage guidance generally positions ESIs after a period of conservative management. For lumbar disc herniation, CMS review notes that the condition can be effectively treated short-term by either transforaminal injection or surgery, but that long-term recurrence rates are high regardless of the treatment chosen. That reality reinforces a diagnosis-driven approach: an injection may resolve the immediate problem, delay or avoid surgery, or clarify whether a structural issue ultimately needs surgical attention.

Source: CMS LCD L36920 | ScienceDirect systematic review, 2022

06 All the Numbers in One Table

07 Frequently Asked Questions