Side Effects of Epidural Steroid Injections

Epidural steroid injections (ESIs) involve the delivery of a steroid medicine, via needle injection, into the epidural space at or above the source of back pain. The injection of the corticosteroid into the epidural space blocks the transmission of pain from traveling beyond that area of the spine. Epidural steroid injections are often used to treat pain symptoms associated with spinal disc herniation and spinal stenosis. The steroid substance in the injection reduces inflammation around the spinal nerves, decreasing the amount of pain that is experienced.

Side Effects of Epidural Steroid Injections: Often, this treatment is both effective in treating pain and inflammation, as well as long-lasting. In some cases, though, the benefits may only be experienced for a short period of time. In other cases, there may be side effects that are related to a single treatment session as well as complication associated with long-term use of this treatment. Most treatment protocols recommend that steroid injections are not performed more than three times in one year. Doctors usually do no give more than one ESI within a 2 month period. Doctors also recommend giving more than 3-4 injections in any one area of the spine.
  • Infections: Though epidural steroid injections don't involve the attachment or removal of tissues, as is done in many types of spine surgeries, all back injections are technically surgeries. Patient who have this procedure must have a ride provided for them to take them home, as they won't be allowed to drive themselves afterwards. Surgical risks and complications may be associated with the skin puncture, the puncture of the spinal, and the body's reaction to the ingredients in the medication. Because of the needle puncture and the puncture of the Dural membranes, there is a risk of infection, however remote. Severe infections occur in 0.1% to 0.01% (one in 10,000) of all injection procedures.



  • Dural Puncture ("wet tap" or "spinal headache"): Between Dural membranes of the spinal canal, these are fluid-filled canals that carry a substance called cerebrospinal fluid. In about 0.5% of epidural steroid injections, the Dura gets punctured, causing this fluid to leak out. When this occurs, the condition is known as a spinal headache, or a post-Dural headache. Though the cause of spinal headaches are due to a spinal canal membrane puncture far from the brain, the pain often is experienced in the head as a severe headache. This headache symptom is often related to body position, and gets worse upon the person standing up. The pain symptoms may be severe, but often alleviate on their own in a few days. In other cases, a medical intervention known as a blood patch may be performed to seal the site of the leak around the spinal sac. To plug this leak, a blood sample is taken from the patient and injected into the epidural space in order to promote clotting around the puncture.

  • Bleeding: Excess and continued bleeding may be a concern for patients with certain blood clotting disorders, such as hemophilia. Because the epidural steroid injections involves such a small needle puncture, the average patient is not at a common risk for bleeding.

  • Nerve Damage: This complication, which involves acute or permanent trauma to the spinal nerves, is extremely rare. The nerves may be damaged due to bleeding, infection, or direct injury from the needle.