Lumbar Epidural Steroid Injections for Prolapsed Disc: Safety and Limits

Epidural steroid injections (ESIs) deliver corticosteroid ± local anesthetic into the epidural space to reduce radicular inflammation from a herniated disc.

Typical Protocol

• Up to 3–4 injections per year, spaced ≥2 weeks apart.
• Most patients need 1–2 for meaningful relief.
• Response assessed at 2–4 weeks; repeat only if >50% pain reduction and functional gain.

Risks (Rare but Serious)

• Dural puncture (post-dural puncture headache)
• Infection (epidural abscess, meningitis)
• Bleeding/hematoma (anticoagulation hold required)
• Nerve injury, stroke (particulate steroid + arterial injection)
• Hyperglycemia (transient, diabetics)

Decision Factors

• Severity/duration of radiculopathy
• Failure of conservative care (PT, NSAIDs, time)
• Surgical candidacy and preference
• Comorbidities (diabetes, coagulopathy, infection)

Shared decision-making with pain/spine specialist. ESIs are a bridge—not a cure; definitive treatment may be surgery or natural resolution.