Sciatica and lumbar radiculopathy - Radiating leg pain, numbness, or weakness from a compressed lumbar nerve root.
What Is an Epidural Injection?
An epidural injection, also called an epidural steroid injection (ESI), is a minimally invasive spinal injection that deposits a precise combination of corticosteroid and local anaesthetic into the epidural space, the narrow channel surrounding the spinal cord and nerve roots inside the vertebral column.
When a disc herniates, a nerve root becomes compressed, or the spinal canal narrows (stenosis), the resulting inflammation causes intense pain that radiates along the nerve pathway, into the leg as sciatica, into the arm, or across the back. Epidural injection delivers a corticosteroid directly to this site of inflammation, suppressing the inflammatory cascade at the nerve root level and providing meaningful, often long-lasting pain relief, without surgery, general anaesthesia, or hospitalisation.
How Does an Epidural Steroid Injection Work?
When a disc herniates or a nerve root is compressed, the body releases inflammatory mediators that sensitise the nerve root and cause radicular pain. Corticosteroid injected into the epidural space suppresses this inflammatory cascade directly at the source, reducing oedema around the affected nerve root, decreasing neural sensitisation, and interrupting the pain cycle, allowing the patient to engage meaningfully with physiotherapy.
Image guidance matters more than many patients realise: studies consistently show that without imaging guidance, up to 30-40% of epidural injections miss the intended target, even in experienced hands. Epidural injection at Nivaan is always performed under fluoroscopic or ultrasound image guidance, ensuring the medication reaches the exact epidural level where the inflammation is occurring, not an approximation.
Types of Epidural Steroid Injections
The needle is inserted between two adjacent vertebral laminae. The most widely used approach for generalised disc-related back pain and bilateral symptoms, delivering medication across a broader area.
- Transforaminal (TFESI) - The needle is directed into the intervertebral foramen where the nerve root exits, delivering steroids closest to the nerve root. The most targeted approach for single-level radiculopathy (sciatica from a specific disc level), with the strongest evidence base for this indication.
- Caudal - Accesses the epidural space via the sacral hiatus at the base of the spine. Particularly useful for lower lumbar and sacral nerve root pain, post-surgical patients with altered anatomy, and elderly patients. Technically simpler, with lower dural puncture risk.
Your specialist will select the approach that best matches your imaging findings and pain pattern.
Conditions Treated with Epidural Injection in Mumbai
Herniated or slipped disc - Disc material pressing against a nerve root, causing local and referred pain.
Spinal stenosis - Narrowing of the spinal canal compressing multiple nerve roots, causing bilateral leg pain and difficulty walking.
Degenerative disc disease - Age-related disc changes causing localised and radicular pain.
Post-surgical back pain - Persistent pain after spinal surgery, often from nerve root scarring.
Cervical radiculopathy - Nerve root pain radiating into the arm, shoulder, or hand from a compressed cervical disc.
Vertebral compression fracture pain - Where nerve inflammation is a component of the pain.
Who Is a Suitable Candidate?
Epidural injection may be the right option if you have:
Radiating nerve pain lasting more than 4-6 weeks despite conservative treatment
Confirmed disc herniation, nerve compression, or spinal stenosis on MRI
Pain not adequately responding to physiotherapy, NSAIDs, or oral steroids
A wish to avoid or delay surgery, where clinically appropriate
A need for pain relief sufficient to enable active physiotherapy
Generally not recommended for active spinal infection, uncontrolled bleeding disorders, uncontrolled diabetes, first-trimester pregnancy where fluoroscopy is involved, active cancer at the injection site, or known allergy to corticosteroids or contrast dye.
Best Doctors for Epidural Injections in Mumbai
The Epidural Injection Procedure, Step by Step
Before the procedure:
- Review of your medical history, medications, and imaging
- Pausing blood thinners and NSAIDs for 7 days, only on medical advice
- Disclosing allergies, particularly to iodine contrast dye
- Diabetic patients advised that blood glucose will be monitored, since corticosteroids cause a temporary rise
What happens during treatment:
- STEP 1Positioning - You lie face down with a pillow supporting your abdomen.
- STEP 2Sterile preparation - The injection site is cleaned, draped, and numbed with local anaesthetic.
- STEP 3Image guidance setup - Fluoroscopy or ultrasound provides live imaging throughout.
- STEP 4Epidural needle placement - The needle is advanced under continuous image guidance; contrast dye confirms correct placement before medication is given.
- STEP 5Injection - The corticosteroid and local anaesthetic solution is slowly injected, taking 20-40 minutes total.
- STEP 6Recovery and discharge - You rest for 20-30 minutes; most patients go home the same day.
Recovery and Aftercare
A temporary increase in pain or a brief flare in nerve symptoms in the 24-48 hours after the injection is normal, it indicates correct needle placement and that the medication is working, not a complication.
| Time | What to Expect |
|---|---|
| Immediately after | Mild soreness; possible temporary leg heaviness from local anaesthetic |
| First 24-48 hours | Possible brief pain flare as steroid begins working |
| Days 3-7 | Local anaesthetic fades; steroid effect begins to build |
| Weeks 1-4 | Progressive reduction in nerve pain |
| Weeks 4-12 | Maximum steroid effect; window for active physiotherapy |
| Months 3-6 | Duration of relief varies; many maintain meaningful benefit |
Diabetic patients should monitor blood glucose closely for 3-5 days post-injection. Epidural injection at Nivaan is always combined with structured physiotherapy, the injection provides the pain window; physiotherapy builds the strength that prevents recurrence.
Benefits, Risks, and Side Effects
Benefits
Targets the root cause - Delivers anti-inflammatory medication directly to the compressed nerve root
Image-guided precision - Confirms correct placement before injection, a standard not met by freehand injection
Non-surgical - No incisions, general anaesthesia, or hospital admission
Rapid pain relief - Many patients notice improvement within days to weeks
Repeatable - Can be administered up to three times per year when clinically appropriate
Risks and Side Effects
Temporary soreness or bruising - Settles within 1-3 days
Brief post-injection flare - Normal, settles within 48 hours
Temporary facial flushing - Settles within 24 hours
Short-term blood glucose elevation - Important for diabetic patients to monitor
Temporary headache - If the dura is inadvertently punctured, managed with rest and hydration
Rare infection or bleeding - Minimised by sterile technique; bleeding risk elevated in patients on anticoagulants
Serious complications, including nerve damage or paralysis, are exceptionally rare when performed under image guidance by an experienced specialist at Nivaan
Epidural Injection Cost Considerations in Mumbai
Cost varies depending on the approach used (interlaminar, transforaminal, or caudal), the spinal level treated, the number of levels injected, and whether fluoroscopic image guidance is included. Given the real risk of unguided injections missing their target entirely, confirming that image guidance is included in any quoted price is worth asking about directly, a lower price without imaging guidance may not represent genuine value.
Results and Number of Sessions
Clinical evidence shows ESI provides significant short-term pain relief in at least half of patients, with many maintaining benefit for 3-6 months.
Days 3-7 - First improvement as steroid effect builds
Weeks 1-4 - Meaningful nerve pain reduction
Weeks 4-12 - Maximum benefit and rehabilitation window
3-6 months - Duration of relief in most responders; some maintain benefit beyond 12 months
Transforaminal epidural injection for acute single-level radiculopathy consistently shows the strongest outcomes. Patients with chronic, long-standing compression tend to see more limited benefit.
Why Choose Nivaan Care for Epidural Injection in Mumbai?
| Epidural Injection | Nivaan Care | Standalone Injection |
|---|---|---|
| Who performs it | Interventional pain specialist under fluoroscopic guidance | General practitioner or clinic |
| Diagnosis | Exact spinal level confirmed before treatment | Symptom-based |
| Injection technique | Fluoroscopy-guided with contrast confirmation | Freehand or landmark-based |
| Approach selection | Interlaminar/transforaminal/caudal chosen per diagnosis | Single approach used for all |
| Rehabilitation | Personalised physiotherapy post-injection | None |
| Follow-up care | Structured, ongoing recovery plan | Rarely structured |
Frequently Asked Questions
They're completely different procedures. Labour epidural anaesthesia uses a continuous catheter and high-dose local anaesthetic to block sensation during childbirth. An epidural injection for back pain uses a single-shot injection of corticosteroid and low-dose local anaesthetic targeted to a specific spinal level to reduce nerve inflammation.
Three main approaches: interlaminar (midline entry, best for bilateral or multi-level pain), transforaminal/TFESI (entry through the nerve root foramen, strongest evidence for sciatica), and caudal (entry via the sacral hiatus, useful for lower lumbar and post-surgical pain).
Yes, generally. Side effects are typically mild and temporary. Serious complications are rare and significantly reduced by fluoroscopic image guidance.
Most patients experience meaningful relief for 3-6 months. Some maintain benefit beyond 12 months, particularly when combined with structured physiotherapy.
Yes, epidural injection is offered as part of Nivaan Care's non-surgical, interventional pain management approach for patients in Mumbai.
The most targeted form of ESI, the needle is guided into the intervertebral foramen, placing corticosteroid as close to the nerve root as possible. Particularly effective for single-level sciatica from a herniated disc.
Humidity, temperature changes, increased fall risk on wet surfaces, and reduced activity during heavy rain can all aggravate existing back conditions. A seasonal flare doesn't necessarily mean the underlying condition has worsened structurally, but it's a reasonable prompt to get properly assessed.