Pain Management

Epidural Steroid Injections

Targeted Relief for Nerve Pain and Inflammation

When spinal nerves are compressed by a herniated disc, bone spur, or stenosis, they often become swollen and painful. This can cause sciatica, arm pain, numbness, or weakness. An epidural steroid injection (ESI) delivers anti-inflammatory medication directly into the epidural space around the nerves, reducing inflammation and pain. At Desert Spine and Pain, neurosurgeon Dr. David L. Greenwald, M.D., FAANS, FACS performs epidural injections using fluoroscopic (X-ray) guidance, ensuring safe, accurate, and effective relief.

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What Is an Epidural Steroid Injection?

  • In simple terms: A steroid and anesthetic mixture is injected near the irritated spinal nerves to calm inflammation and relieve pain.

  • Scientifically: ESI involves percutaneous placement of a spinal needle into the epidural space (interlaminar, transforaminal, or caudal) under fluoroscopy, with injection of corticosteroid and anesthetic to suppress pro-inflammatory mediators and improve radicular pain.

Conditions Treated

  • Herniated discs causing sciatica or arm pain

  • Spinal stenosis

  • Radiculopathy (pinched nerve symptoms)

  • Sciatica

  • Recurrent nerve inflammation after back surgery

  • Chronic pain not responding to conservative care

Types of Epidural Steroid Injections

1. Interlaminar ESI

  • Needle placed between vertebrae into posterior epidural space.

  • Medication spreads to multiple levels.

2. Transforaminal ESI

  • Needle directed into the foramen (nerve root exit).

  • Highly targeted—ideal for pinched nerve at a single level.

3. Caudal ESI

  • Needle inserted into epidural space through sacral opening.

  • Useful when multiple levels or prior surgeries limit access.

The ESI Procedure: Step by Step

Plain-English Overview

  1. Preparation: Outpatient procedure; local anesthesia with mild sedation if needed.

  2. Needle placement: Guided into epidural space using live X-ray.

  3. Contrast dye: Confirms correct needle location.

  4. Steroid injection: Medication delivered around irritated nerves.

  5. Observation: Short recovery; home same day.

Surgeon-Level Detail

  • Positioning: Patient prone; sterile prep and draping.

  • Needle placement: 22G spinal needle advanced under AP/lateral fluoroscopy.

  • Contrast injection: Non-ionic contrast injected to confirm epidural spread; no intrathecal or intravascular uptake.

  • Medication: Mixture of corticosteroid (e.g., triamcinolone, dexamethasone) and anesthetic injected slowly.

  • Closure: Needle removed; sterile dressing applied; patient monitored briefly.

Benefits of Epidural Steroid Injections

  • Targeted delivery of medication

  • Relief from nerve pain, sciatica, and inflammation

  • Outpatient procedure with minimal downtime

  • Can delay or avoid major surgery

  • Helps confirm diagnosis by identifying pain source

Risks & Limitations

  • Temporary soreness or headache

  • Infection, bleeding, or nerve injury (rare)

  • Relief may be temporary—weeks to months

  • Not a cure for structural instability

  • Multiple injections may be needed for lasting benefit

Recovery Timeline

  • Day 0: Mild soreness possible; most resume light activity same day

  • Days 1–3: Pain relief may begin; steroid effect builds gradually

  • Weeks 1–2: Maximum benefit usually seen

  • Months: Relief may last weeks to months; repeat injections may be recommended



Why Choose Desert Spine and Pain?

  • Neurosurgeon-led expertise: Dr. Greenwald ensures precise placement under fluoroscopy

  • Safe and effective: Real-time imaging minimizes risk and maximizes accuracy

  • Patient-first philosophy: We explain every step to reduce anxiety and build confidence

  • Comprehensive approach: Injections used alongside PT, medications, or surgery as needed

Frequently Asked Questions

How long do epidural injections last?

Relief may last from a few weeks to several months, depending on condition and severity.

How many injections can I have?

Most patients receive up to 3 per year, spaced out for safety.

Are epidural injections painful?

Mild pressure may be felt, but most patients tolerate the procedure well.

Do epidural injections replace surgery?

Sometimes. For many patients, injections provide enough relief to delay or avoid surgery, but if compression is severe, surgery may still be needed.

How does Desert Spine and Pain perform ESIs differently?

We use fluoroscopy, neurosurgical precision, and patient-tailored dosing, ensuring maximum relief with the highest safety standards.

Dr. David L. Greenwald, MD

Neuro-Spine Surgeon

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If you’re suffering from persistent back, neck, or nerve pain, epidural steroid injections may provide the relief you’ve been looking for. Dr. Greenwald and his compassionate team will carefully evaluate your condition, review imaging, and determine whether this targeted treatment is right for you. Every step you take toward pain relief brings you closer to comfort and restored mobility. Schedule your consultation today and let Dr. Greenwald help you move forward with confidence and less pain.

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Dr. David L. Greenwald, M.D., F.A.C.S.

Neurosurgeon | Spine Surgeon | Regenerative Medicine

Dr. David L. Greenwald, MD, FACS, is a board-certified spine surgeon with extensive experience performing epidural steroid injections (ESIs)—a highly effective, minimally invasive treatment for back, neck, and nerve pain caused by conditions such as herniated discs, spinal stenosis, or degenerative disc disease. These injections deliver a powerful anti-inflammatory medication directly into the epidural space surrounding the spinal nerves, reducing inflammation and relieving pain that radiates into the arms or legs. Using advanced image-guided precision, Dr. Greenwald ensures safe, accurate placement for maximum effectiveness and minimal discomfort. His patient-focused approach helps individuals throughout South Florida experience reduced pain, improved function, and better quality of life without the need for surgery.

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