It's usually a quick 5 minute procedure. Patients with complex spinal disease having more technically challenging injection placements may take 10-20 minutes.

For most patients, it's not a painful procedure. It's normal to feel pressure down the arm (for neck procedures), or leg (for back procedures) when we inject medication into the epidural space. The pressure sensation can be helpful from a diagnostic point of view. If the injection reproduces pressure where you ordinarily have pain, that helps to confirm the diagnosis.

We do our injections under x-ray guidance and follow the most up-to-date protocols in the medical literature to maximize safetly. Injuries are exceedingly rare, but possible, and generally avoidable by using appropriate technique and safety checks. Dr. Littlejohn has never had any serious complications of an epidural injection.

Onset of effect is generally 2-3 days, with maximum relief at 2 weeks.

This is quite variable between patients and it's hard to give an accurate estimate. If a patient is doing well at two weeks, relief may continue for months or even years.

We plan on doing the first injection, and then assessing response at two weeks before deciding on further injections. If a patient achieves 75%+ pain relief with the first injection, it's wise to wait and watch at that point. Patients having 25-50% improvement may benefit from another injection to see if 75% or more is possible. If a patient has less than 25% pain relief, we need to re-evaluate the problem and look for a better approach.

All insurances cover epidural steroid injections, however they have restrictions that differ from plan to plan. Many will require prior-authorization which means the procedure can not be done on the same day that you're evaluated.

Epidural injections can be done by three major routes. The most common would be the "inter-laminar" approach, which goes between the posterior bones of the vertebrae. This is how a labor epidural is performed. The "caudal" approach is another approach specific to back and leg pain. This is done at the bottom of the sacrum (top of the "crack"), where there is a small gap in the bones. Finally, the "transforaminal" approach is performed by placing a needle in the lateral part of the vertebrae where the nerves actually exit the spine. We usually start with the simpler interlaminar or caudal techniques and reserve the transforaminal apprach for cases not responding adequately to the initial injection.