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Epidural injection
Targeted delivery of an anti-inflammatory medicine. The aim is to reduce radicular pain and related limitations.
How the injection is performed →Professor Iakiv Fishchenko · Kyiv
Epidural
steroid injections
Targeted injections under X-ray guidance
Reducing radicular pain after assessment of your symptoms and MRI. From an appropriately selected injection to surgical treatment when indicated.
Send MRI scans for a preliminary reviewThe professor's preliminary review of existing scans is free.
An injection may reduce pain, but does not remove a disc herniation or correct bony stenosis.
Doctor of Medical SciencesSpinal surgeon
Honoured Doctor of Ukraine
Understanding the method
What is an epidural steroid injection?
An epidural steroid injection is the targeted delivery of an anti-inflammatory corticosteroid into the epidural space, outside the dura, at the planned nerve-root area.
The aim is to reduce inflammation and radicular pain, such as pain radiating from the lower back into the leg. This may make movement and a return to rehabilitation easier.
The term 'block' is used for different procedures. Not every injection near the spine is epidural, and not every injection contains a steroid. The procedure must be specified before treatment.
Important distinctions
- Corticosteroid
- Anti-inflammatory action; its effect may develop gradually.
- Local anaesthetic
- May be added for pain relief; its early action is not the same as the steroid's eventual effect.
- Treating the cause of compression
- The injection does not directly remove a disc herniation or correct bony stenosis.
Sources: The professor's patient information: epidural injections · AAN, 2025: systematic review of epidural steroid effectiveness.
Patient selection
When an injection may be appropriate
We assess symptoms, not just the MRI report
- Pain radiates into the leg or arm and is consistent with nerve-root involvement.
- Symptoms, neurological examination and imaging findings are consistent with one another.
- Previous treatment and activity limitations provide reasons to discuss an injection.
- The expected benefit outweighs the individual risks.
When a different assessment is needed
Isolated non-specific low back pain or an incidental finding of a disc protrusion is not an automatic indication.
For central spinal stenosis with neurogenic claudication — pain and limited walking — improved walking should not be promised after an epidural steroid injection. NICE does not recommend epidural injections for this situation.
Cervical and lumbar approaches have different features and risks. A plan for one spinal region is not automatically suitable for another.
Sources: NICE NG59: epidural injections for sciatica and limitations in stenosis · AAN, 2025: systematic review of epidural steroid effectiveness.
Accurate delivery
X-ray guidance is part of a targeted procedure
MRI helps plan treatment. X-ray guidance during the procedure helps check the position of the needle.
Our team performs epidural injections under X-ray guidance. When there are no contraindications, contrast is used to check the spread of the medication.
A targeted epidural procedure should not be equated with injecting medication into the back muscles without imaging the target area.
Preparation and the injection procedure →What we check before injection
- The correct level, approach and side of the procedure.
- Needle position and an appropriate method of contrast confirmation.
- Allergies, medicines and individual risks.
X-ray or CT guidance during a procedure has a different purpose from the earlier MRI: it helps visualise instrument position. Our team uses X-ray guidance.
Sources: The professor's patient information: epidural injections · ASIPP, 2021: guidelines on epidural interventions and catheter adhesiolysis.
Different aims
Injection, adhesiolysis or surgery?
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Epidural adhesiolysis
A catheter procedure involving treatment of adhesions and delivery of medication. A separate option for selected patients with persistent pain.
About catheter adhesiolysis →03
Surgical decompression
Directly relieving pressure on a nerve when compression is confirmed and surgery is indicated. The method is chosen after assessment.
Endoscopic treatment on SPINA →These are different treatments. Adhesiolysis is not a mandatory next step after an injection, and injections should not delay necessary surgery.
Benefits and limitations
What results to expect
Pain and related limitations may improve, mainly in the short term.
The 2025 AAN review supports a limited benefit from epidural steroids for radicular pain. Evidence of long-term pain reduction is insufficient. The response in stenosis differs from the response in radiculopathy.
Complete pain relief, a specific duration of benefit or avoidance of surgery cannot be guaranteed.
There is no automatic series of three injections
We first assess the response to one procedure: pain, sleep, walking, work and medication needs. Further injections are considered when indicated, taking account of the previous response and cumulative steroid exposure.
If there is no benefit, or it is short-lived, we reassess the diagnosis and treatment alternatives.
Sources: AAN, 2025: systematic review of epidural steroid effectiveness · The professor's patient information: epidural injections.
Safety
We discuss risks before a treatment decision
Possible adverse effects
Temporary worsening of pain, numbness or weakness, headache following dural puncture, raised blood glucose and reactions to medicines.
Bleeding and infection are also possible. Rare, severe neurological complications cannot be ruled out completely. X-ray guidance does not eliminate all risks.
What you need to tell us
Tell us about infection, allergies, diabetes, pregnancy and medicines that affect blood clotting. Active infection, an uncorrected clotting disorder or an allergy to a required medicine may prevent the procedure from going ahead.
Do not stop anticoagulants or antiplatelet medicines on your own. The doctors will agree a safe plan.
Sources: The professor's patient information: epidural injections · FDA: work on rare, serious neurological complications of injections.
Patient information
From preparation to follow-up
Before the procedure
Preparation and the procedure
What to tell the doctor, how medication is administered, and what to agree in advance.
Read more →After the procedure
Recovery and follow-up
How you may feel, driving, activity, assessment of the response and warning signs.
Read more →Persistent pain
Epidural adhesiolysis
When a catheter procedure may be considered and why an MRI scar is not a diagnosis on its own.
Read more →
Professor Iakiv Fishchenko
One team.
An informed choice of treatment.
Doctor of Medical Sciences, Professor and Honoured Doctor of Ukraine. Holds Ukraine's highest medical qualification category; practising in the specialty since 2004.
We combine assessment of symptoms and MRI with targeted injections and surgery when indicated. The aim is to choose the treatment you need and avoid delaying necessary nerve decompression.
President of the Ukrainian Association of Endoscopic Spine Surgery. Member of the Scoliosis Research Society, AO Spine and the American Academy of Orthopaedic Surgeons.
Practical information
Cost of injections and adhesiolysis
A cost estimate after consultation
We confirm the total price and included services once the procedure has been chosen. Before treatment, you should understand which medicines, materials and monitoring are included.
Administrator: +38 094 821 08 30What affects the cost
- Type of procedure and approach.
- Medicines, contrast and consumables.
- Anaesthesia and monitoring arrangements.
A free preliminary scan review does not mean that an in-person consultation or procedure is free.
Brief answers
Frequently asked questions
Is an epidural injection just an ordinary injection in the back?
No. The doctor delivers medication to a defined epidural area under imaging guidance. Our team uses X-ray guidance. An injection into the back muscles is not an epidural injection.
Can an injection help with a herniated disc?
It may be considered for radicular pain when the symptoms and examination findings are consistent with the images. It acts on inflammation and pain, but does not remove a herniated disc fragment.
Do I need three injections in a row?
There is no mandatory series. The response to one procedure is assessed first. Further injections are considered when medically indicated, taking cumulative steroid exposure into account.
How long does the effect last?
The degree and duration of relief vary. The best-supported benefit for radicular pain is mainly short-term. Lasting or complete pain relief cannot be guaranteed.
Can an injection replace necessary surgery?
An injection does not relieve mechanical pressure on a nerve. Progressive weakness or bladder problems require urgent assessment. When surgery is indicated, injections should not cause an unjustified delay to necessary treatment.
How is epidural adhesiolysis different?
It is a catheter procedure involving targeted medication delivery and a planned intervention on epidural adhesions. It is considered separately for selected patients with persistent pain, not automatically after an unsuccessful injection.
How much does an injection or adhesiolysis cost?
A cost estimate is provided after consultation. The price depends on the procedure, medicines, materials and monitoring. Before treatment, confirm the total price and included services with the administrator.
Next step
Let's start with your symptoms and MRI
Send your existing scans and a brief treatment history.
We will explain whether an injection or adhesiolysis may be appropriate, or whether another treatment should be discussed. The preliminary scan review is free.