Spinal Injections

They treat different pain sources. An epidural steroid injection places medicine around irritated spinal nerves and is used for pain that travels into a leg or arm^[1]. A facet joint injection or medial branch block targets the small joints at the back of the spine, a common source of aching back or neck pain^[2]. An SI joint injection targets the joint between the spine and pelvis, for pain low in the back and buttock^[3].

Your physician decides based on where your pain is, what makes it worse, your exam and your imaging. Leg or arm pain with numbness or tingling points to a nerve root; pain that stays in the back or neck and worsens with leaning back or twisting points to the facet joints; one-sided pain below the belt line points to the SI joint. Sometimes more than one source is involved, and a diagnostic block is the clearest way to tell.

Most people find spinal injections uncomfortable rather than painful. The skin is numbed first, thin needles are used and live X-ray guides placement, so most procedures take 15 to 30 minutes. You may feel pressure or a brief echo of your usual pain as the medicine goes in. Most people need little or no sedation, and some soreness at the injection site for a day or two is common.

It depends on the injection and the person. Diagnostic blocks are meant to work only for hours, while the numbing medicine is active. Steroid injections may help for longer, but research shows the clearest benefit in the short term — for epidural injections, mostly within the first three months^[4]. Because injections by themselves are not likely to provide long-term relief, they work best alongside exercise and physical therapy^[9].

Guidelines limit steroid injections to a few per year in each region of the spine and allow repeats only when the last injection clearly helped. For example, Medicare’s policy for New York allows up to four epidural sessions per spinal region in a rolling 12 months, and each repeat requires at least 50% improvement lasting three months or more^[6]. Your physician will weigh the benefit against the cumulative effects of steroids.

Serious complications are rare when injections are done with image guidance by experienced physicians, but no procedure is risk-free. Common effects include soreness, a short pain flare, light-headedness and a brief rise in blood sugar^[9]. The FDA has not approved corticosteroids for epidural use and requires a label warning about rare but serious neurologic events after epidural injection^[5]. Your physician will explain the specific risks of the injection recommended for you.

Medicare and most commercial plans cover epidural, facet and SI joint injections when coverage criteria are met, such as a documented trial of conservative care and image guidance^[6][7][8]. Commercial plans often require prior authorization. New York workers’ compensation follows the Board’s Medical Treatment Guidelines^[9], and no-fault claims have their own rules. We accept many plans, including Medicare, workers’ compensation and no-fault, and verify your benefits before scheduling.

A lack of relief is useful information: it suggests the injected structure may not be your main pain source, and your physician may test another one. If injections help but wear off, spinal radiofrequency ablation or SI joint radiofrequency ablation may give longer relief. Other options include spinal cord stimulation and minimally invasive spine procedures, alongside continued physical therapy.