Epidural Steroid Injection

Cervical, Thoracic, Lumbar, Sacral, Caudal

During an epidural injection a liquid anti-inflammatory (steroid) medication is injected into the epidural space. (The anatomy of the epidural space between tissue layers surrounding the spinal cord is as much a “space” as is the gap between two sheet layers on your bed.) Inflammation in the epidural space can irritate nerve tissue and cause symptoms commonly referred to as “sciatica” or a “pinched nerve”. Degenerative changes from spine arthritis and spine disc abnormalities are common causes of inflammation in the epidural space.

The use of steroids in the epidural space is a common off label use for this class of medication, however doing so still remains an alternative for patients to consider, especially if their goal is to avoid spine surgery.



Self Pay Rates:

Cervical Epidural- $310+

Thoracic Epidural- $440+

Lumber Epidural- $310+


ProNox Add On: $50

What to expect during your Epidural Steroid Injection

What to Wear: On the day of your  injection, wear loose, comfortable clothing for easy access to the targeted area. Choose exercise or lounge wear without metal to avoid blocking x-ray visualization.

Driver Required: Always have a driver take you home after your injection. Numbing medicine may slow your foot pedal reaction time, so a driver is essential for at least 4 hours after the injection, for your safety and others. Plan for 90 minutes total time for the procedure and observation.

Injection Safety & Risk Management: When you and Dr. Tolman decide to move forward with plans to perform an injection, he will ask a detailed series of questions with your safety in mind. The risk of any medical procedure is never 0% but working together with Dr. Tolman you can reduce the risk as low as possible.

Procedure Related Anxiety and Mild Sedation Options:

If you would benefit from mild sedation in order to go through with your procedure, a medication can be prescribed to you in advance during the office visit to schedule your procedure. This prescription should be filled enough in advance so can swallow the tablet at home two hours before the scheduled time of your  procedure. If any type of sedation is used during your procedure then you should not drive until the following day after you have had a full night sleep. An additional option to make you more comfortable is the use of Nitrous Oxide “laughing gas” during your procedure.

Blood Thinners: There are many over-the-counter and prescription medications that are designed specifically to thin your blood and there are many others that thin your blood as a side effect. All of these medications make injections more risky because they cause you to bleed excessively in and around the treatment site after the injection needle is removed. When planning your procedure Dr. Tolman will go through a long list of these medications to make the injection as safe as possible by minimizing your bleeding risk. You can help by reviewing these lists beforehand and notify Dr. Tolman if you are taking any of these over-the-counter or prescription medications:

Aspirin containing medications thin the blood up to 7 days:


  • Aspirin (ASA – acetyl salicylic acid).
  • Adprin
  • Aggrenox
  • Alka-Seltzer
  • Anacin
  • Ascriptin
  • Aspergum
  • Bayer
  • Bayer Back & Body



  • Bufferin
  • Doan’s Pills
  • Easpirin
  • Ecotrin
  • Endodan
  • Equagesic
  • Excedrin
  • Fiorinal
  • Fortabs
  • Gelpirin
  • Genacote
  • Goody’s Extra Strength
  • Halfprin
  • Magnaprin
  • Norwich
  • Norgesic
  • Orphengesic
  • PC-CAP
  • Percodan
  • Robaxisal
  • Roxiprin
  • St. Joseph’s
  • Supac
  • Sureprin
  • Synalgos-DC
  • Soma-compound
  • Talwin-compound
  • Vanquish
  • ZORprin
  • Willow Bark Extract


Prescription Blood Thinners all work differently and for different lengths of time:


 Trade name in parentheses


Supplements can also thin the blood:

Fish Oil, Garlic, Ginkgo Biloba, Ginseng, Willow Bark Extract

  • apixaban (Eliquis)
  • betrixaban (Bevyxxa)
  • cilostazol (Pletal)
  • clopidogrel (Plavix)
  • dabigatran (Pradaxa)
  • dalteparin (Fragmin)
  • danaparoid (Orgaran)
  • dipyridamole (Persantine)
  • 


  • edoxaban (Savaysa)
  • enoxaparin (Lovenox)
  • fondaparinux (Arixtra)
  • heparin
  • low molecular weight heparin (Lovenox) 
  • pentosan polysulfate sodium (Elmiron)
  • pentoxifylline (Trental)
  • prasugrel (Effient)
  • rivaroxaban (Xarelto)
  • ticagrelor (Brilinta)             
  • ticlopidine (Ticlid)
  • tinzaparin (Innohep)
  • warfarin
  •  (Coumadin)

To plan appropriately Dr. Tolman needs to know which of these prescription or over-the-counter NSAIDs you take regularly, occasionally, or even rarely:


 Trade name in parentheses

  • diclofenac (Arthrotec, Cataflam, Flector, Voltaren, Zipsor, Zorvolex)
  • diflunisal(Dolobid)
  • etodolac (Lodine)
  • fenoprofen (Nalfon)
  • flubiprofen (Ansaid)
  • ibuprofen (Advil, Combunox, Dolgesic, Duexis, Genpril, Halpran, Medipren, Motrin, Nuprin, Pamprin, Q-Profen, Rufen, Trendar, Tab-Profen, Vicoprofen)


  • Indomethacin (Indo-Lemmon, Indocin,Indomethagan)
  • ketoprofen (Actron, Orudis, Oruvail)
  • ketorolac (Toradol)
  • meclofenamate (Meclomen)
  • mefenamic acid (Ponstel)
  • meloxicam (Mobic)
  • nabumetone (Relafen)
  • naproxen (Aleve, Anaprox, Naprapac, Naprelan, Naprosyn, Naproxyn, Vimovo)
  • oxaprozin (Daypro)
  • phenylbutazone (Cotylbutazone)
  • piroxicam (Feldene)
  • salsalate (Disalcid , Trilisate)
  • sulfasalazine (Azulfidine)
  • sulindac (Clinoril)
  • tolmetin (Tolectin)

Blood Clotting Disorders

 Notify Dr. Tolman & his team if you have a blood clotting disorders hemophilia, low platelets, etc. to avoid bleeding complications from the spine injection. 

Infection(s)

You should not get an injection if you have an infection anywhere in your body – even a cold or flu! Whether or not you are taking antibiotics there is a chance of moving that infection into your central nervous system causing meningitis. Make sure to tell Dr. Tolman & his team if you have had a recent infection – even if you are taking antibiotics and no longer feeling the symptoms of the infection.

Recent Dental Work

 Bacteria can enter your bloodstream during routine dental cleaning even if you have healthy teeth and gums. Make sure that you notify Dr. Tolman & his team if you have had any dental work in the 2 weeks prior to your scheduled  procedure to avoid infection complications in the central nervous system such as meningitis. 

Dye Allergy

Notify Dr. Tolman & his team if you have an allergy to or x-ray dye (contrast). It is possible to perform injections without x-ray dye (contrast). 

The skin over the targeted landmark will be injected with numbing medicine, which causes a very temporary sensation like a “bee sting”. Most patients agree that the numbing of the skin is the most unpleasant part of the entire procedure (fortunately it is very brief) and the rest of the process feels like movement and pressure rather than pain.

Each needle movement is verified by the fluoroscope to ensure your safety and your comfort. Once the needle tip is in the ideal position relative to the bone landmarks, a small amount of x-ray dye (contrast) is injected. This dye is visible on the fluoroscope and Dr. Tolman uses it to verify that the flow of the dye goes into the epidural space and to make sure blood vessels are not carrying it away from the target. (If you have an x-ray dye allergy, this verification step with the x-ray dye cannot take place.)

The final step is slowly injecting the treatment medication into the epidural space precisely to the desired location. A bandage will be applied to the injection site and you be escorted back to the original exam room for the after injection observation, monitoring, and discharge process.

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