Epidural Steroid Injection, Lumbar Spine



  • Corticosteroid/anesthetic injection into lumbar epidural space via interlaminar, transforaminal, or caudal approach


  • Indications

    • Lumbar radiculopathy

    • Residual pain following vertebroplasty/kyphoplasty

  • Things to check

    • Prior imaging: Adequate epidural space (especially important in postoperative back!)

  • Avoid interlaminar approach in patient with severe canal stenosis without identifiable epidural space on preprocedure imaging

  • Literature supports use of nonparticulate steroid (dexamethasone) to minimize possibility of small vessel vascular embolization


  • Interlaminar epidural steroid injection (ESI)

    • Target superior lamina near midline

  • Transforaminal ESI

    • Target superomedial neural foramen

  • Caudal ESI

    • Target sacral hiatus at midline, and consider catheter placement in patients requiring higher lumbar level injections

Post Procedure

  • Expectations

    • Reproduction of pain with needle placement/injection

    • Significant improvement in pain after injection


  • Most feared complications

    • Intravascular injection/spinal cord ischemia

    • Spinal cord puncture

Severe Central Canal Stenosis

Needle Placement: Interlaminar ESI

Transforaminal ESI

Contrast Spread in Dorsal Epidural Space


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