Injections / Epidurals

Epidural steroid injections are used to help reduce inflammation and relieve nerve pain that radiates down an arm or leg due to compression of a spinal nerve (a pinched nerve) or inflammation of a nerve. These injections are made in the epidural space- the space outside the fluid sac that surrounds the spinal cord. The injection is made over the compressed spinal nerve root where the pain originates.

Epidural spinal injections are used for two different purposes:

  1. Diagnosis: Epidurals may be used to diagnose the source of your pain and the affected nerve that causes pain to radiate from the spine to the legs, neck or arms.
  1. Treatment: Therapeutic epidurals use a corticosteroid – an anti-inflammatory medication – plus an anesthetic, to reduce pain and inflammation in the affected nerve(s). Lumbar back pain is commonly due to a disc herniation or disc disease. Sciatica pain, due to disc herniation is common and can benefit from therapeutic epidural therapy.

Typically, an epidural is used to treat disabling pain that has failed to improve with medication, therapy and other noninvasive treatments. It is not a cure. Usually, epidural injections are used as part of a comprehensive treatment plan that may include an exercise program to improve mobility and stability.

Anatomy of the Spine

Below is a diagram of the spinal canal and the epidural space. Note that the steroid injection is placed in the epidural space, the anatomic compartment between the spinal cord and the vertebral canal. It is the outermost part of the spinal canal.

epidural space PE-ESI_Figure2

Spinal Epidurals are not the same as spinal nerve blocks. In spinal blocks, the needle is placed IN the spinal sac, not in the epidural space. The nerves are bathed in the medication which blocks out the pain. This is anesthesia. A good example of a spinal block is the anesthesia given to a woman in labor. It is also used as anesthesia for regional surgeries.

Preparing for an Epidural

The spinal experts at Orthopaedic Specialists of North County will provide you with specific instructions. It is important to provide complete information about the medications you take, including herbs and supplements. You may be advised to discontinue any medication that can prevent your blood from clotting.

The Procedure:

(The procedure is usually done in an ambulatory surgery center or outpatient clinic)

  • You will change into a gown and your vitals will be taken.
  • You will lie down on an x-ray table face down with a pillow under your stomach.
  • Your back will be cleaned where the injection will be made. You will receive a local anesthetic in the area where the epidural is to be performed, to numb the area so that you do not feel the epidural needle.
  • The injection is performed under fluoroscopy- a live x-ray- that helps the doctor guide the needle to the correct spot, and confirms proper placement of the medication.
  • The medication helps decrease swelling and pressure to reduce the pain.
  • The entire procedure may take 15-30 minutes.

Risks and Complications

As with any surgical procedure, complications can occur. They may include:

  • Mild dizziness, headache or nausea
  • Infection
  • Bleeding around the spinal cord
  • Allergic reaction to the medication
  • Nerve damage

The board-certified orthopedic specialists at Orthopaedic Specialists of North County provide services to patients in Greater San Diego County, Oceanside, Vista, San Marcos, Encinitas and Solana Beach.

Our doctors are experienced, skilled experts in orthopedic surgery. Our specialties include work and sports related injuries, trauma, and arthritis. We focus on arthroscopic and minimally invasive surgery and procedures designed to restore range of motion, coupled with comprehensive care to obtain excellent outcomes. Additionally, our staff of rehabilitative physical therapists will help you regain function, stability, mobility and independence.

Our goal is to restore your function and free you from pain so you can live independently and stay active. When you suffer from musculoskeletal problems, sports injuries, occupational injuries, degenerative diseases of the skeletal system and a variety of conditions and injuries, Orthopaedic Specialists of North County San Diego welcomes the opportunity to serve you with care, compassion and advanced treatments and technologies. We have clinics in Oceanside and Carlsbad with on-site MRI, and Physical Therapy offices in Vista and Carlsbad. Give us a call. We’ll help you get back your life.


"The entire team at OSNC is great, very professional and took the time to put me at ease. And I only have praise for the Dr. Erik Stark, a wonderful doctor who never disappoints!" Patient of Dr. Erik Stark
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