What are the serious risks of epidural steroid injections?

MedlinePlus says side effects such as dizziness or headache are mild most of the time. But the FDA-approved Kenalog-40 label warns that serious neurologic events, including paraplegia, quadriplegia, stroke and some deaths, have been reported with epidural corticosteroid injection, and states that corticosteroids are not approved for this use. Infection, bleeding and nerve damage are other listed risks (MedlinePlus).

How long does an epidural steroid injection last?

MedlinePlus says it gives short-term relief to at least half of the people who receive it, and symptoms may stay better for weeks to months, but rarely up to a year. The steroid usually takes 3 to 5 days to start working.

How many epidural steroid injections can you have?

MedlinePlus says most providers limit people to two or three injections a year, because injections given too often may weaken the spinal bones or nearby muscles. The AAOS advises no more than three a year for spinal stenosis.

Is it the same as an epidural for childbirth?

No. MedlinePlus notes that an epidural steroid injection is not the same as the epidural anaesthesia given before childbirth or certain surgeries.

A clinician in blue gloves preparing a syringe

Spine procedure · plain-English guide

Epidural steroid injection

Photo: Gustavo Fring / Pexels

An epidural steroid injection delivers anti-inflammatory medicine into the space around the spinal nerves to relieve pain that spreads from the spine into a leg or arm. MedlinePlus says it gives short-term relief to at least half of the people who have it. The FDA-approved label for Kenalog-40, an injectable corticosteroid, warns that serious neurologic events, some resulting in death, have been reported after epidural injection.

Overview

The injection puts a mixture of steroid and numbing medicine into the epidural space, just outside the sac of fluid around the spinal cord, to reduce swelling and pressure around the nerves (MedlinePlus). It is not the same as the epidural anaesthesia used in childbirth.

MedlinePlus says a provider may recommend it for pain that spreads from the lower spine to the hips or down the leg, caused by pressure on a nerve as it leaves the spine, most often from a bulging disc, and only when medicines, physical therapy or other nonsurgical treatments have not helped.

Injections are done under X-ray guidance (fluoroscopy) to confirm where the medicine goes (AAOS OrthoInfo). For a herniated disc, the AAOS notes that nonsurgical treatments such as these do not heal the disc; they can help relieve symptoms while the body heals it.

Why it is done

Pain that starts in the spine and spreads into an arm or leg, which often happens when a nerve is inflamed or compressed (AAOS OrthoInfo)
When medicines, physical therapy or other nonsurgical treatments have not helped (MedlinePlus)
Sometimes to find which nerve is causing the pain: if an injection at one specific nerve completely or nearly completely relieves the pain, that nerve is the primary cause (AAOS OrthoInfo)

What happens

You lie face down on an X-ray table, or on your side if that is more comfortable
The skin is cleaned and may be numbed, and you may be given medicine to help you relax
Your provider likely uses real-time X-ray to guide the needle to the right spot (MedlinePlus; the AAOS says spinal injections are done under X-ray guidance), and the steroid and numbing mixture is injected
You are watched for 15 to 20 minutes before going home (MedlinePlus)

Recovery

Soreness where the needle went in should last only a few hours (MedlinePlus)
Pain can get worse for 2 to 3 days before it improves; the steroid usually takes 3 to 5 days to work
You may be told to take it easy for the rest of the day, and need someone to drive you home if you were given medicine to make you sleepy

FDA label warning: serious neurologic events

The FDA-approved prescribing information for Kenalog-40, an injectable corticosteroid, warns that serious neurologic events, some resulting in death, have been reported with epidural injection of corticosteroids. Reported events include spinal cord infarction, paraplegia, quadriplegia, cortical blindness and stroke, with and without X-ray guidance. The label states that the safety and effectiveness of epidural use have not been established and that corticosteroids are not approved for this use.

Read the FDA label warning

Risks

Dizziness, headache or feeling sick to your stomach, usually mild
Infection in or around the spine, or bleeding around the spinal column
Allergic reaction to the medicine, or nerve root damage with increased leg pain
Difficulty breathing if the injection is in the neck
A rise in blood sugar, which is usually temporary (AAOS OrthoInfo)
Having injections too often, or at higher doses, may weaken the spinal bones or nearby muscles, so most providers limit people to two or three injections a year (MedlinePlus)

Results

MedlinePlus says the injection gives short-term pain relief to at least half of the people who receive it. Symptoms may stay better for weeks to months, but rarely up to a year.

What it costs, and how to find out

SpinalCare does not publish a price for these procedures, because no cited source gives one figure that would apply to you.

Since January 1, 2021, US hospitals have had to publish their standard charges online, free of charge. That includes the rates they negotiate with insurance companies and the discounted price they will accept if you pay in cash (CMS).

Hospitals must also show prices for at least 300 "shoppable" services that can be planned in advance, in a consumer-friendly format. The rule applies to hospitals. CMS suggests checking these charges before you receive care, and using Medicare's Care Compare to look at quality information for over 4,000 Medicare-certified hospitals.

Watch: a short explainer

Mayo Clinic Minute: Benefits and risks of corticosteroid shots
Mayo Clinic · Mayo Clinic (academic medical centre)
A one-minute Mayo Clinic overview of the benefits and risks of corticosteroid shots in general, not epidural injections specifically. We embed it for general education.

Frequently asked

What are the serious risks of epidural steroid injections?: MedlinePlus says side effects such as dizziness or headache are mild most of the time. But the FDA-approved Kenalog-40 label warns that serious neurologic events, including paraplegia, quadriplegia, stroke and some deaths, have been reported with epidural corticosteroid injection, and states that corticosteroids are not approved for this use. Infection, bleeding and nerve damage are other listed risks (MedlinePlus).
How long does an epidural steroid injection last?: MedlinePlus says it gives short-term relief to at least half of the people who receive it, and symptoms may stay better for weeks to months, but rarely up to a year. The steroid usually takes 3 to 5 days to start working.
How many epidural steroid injections can you have?: MedlinePlus says most providers limit people to two or three injections a year, because injections given too often may weaken the spinal bones or nearby muscles. The AAOS advises no more than three a year for spinal stenosis.
Is it the same as an epidural for childbirth?: No. MedlinePlus notes that an epidural steroid injection is not the same as the epidural anaesthesia given before childbirth or certain surgeries.

Sources

This page organises information from the cited sources for general education. It is not medical advice and has not been reviewed by a clinician. Always discuss a procedure with a qualified clinician. Editorially reviewed October 4, 2026.