Spine injections and epidurals may help evaluate or reduce selected neck, back, arm, or leg pain related to irritated spinal nerves, disc herniations, spinal stenosis, or complex spine conditions.
Learn how Dr. Siefferman performs epidural spine injections to help reduce inflammation, relieve nerve pain, and improve function for patients with neck and back conditions.
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Hi, I’m Dr. Jason Siefferman, Medical Director at 91视频 and Interventional Pain Specialist. Epidural injections are one of the more frequent procedures we do because disc herniations are common. It’s important to know that not all epidurals are the same. It really depends on the intention of the epidural. What do we want to accomplish with the epidural, because many different things can be done with the epidural?
First of all, an epidural just means that it’s an injection within the space between the thecal sac, which holds the nerves in the spine, and the bony spinal canal. This is the space where, if a disc herniates, it pushes into the space and engages with the nerve root. This is also a space where scar tissue will build up from recurrent disc herniations or from spine surgery.
With an epidural, based on our approach, we can target that disc-nerve interface from a variety of directions. We can also use a variety of different medications to accomplish different ends. So based on what your needs are, if an epidural makes sense, we will discuss how that epidural could be used to accomplish the specific mechanical outcome that we want to achieve.
To recap, we can do a lot with epidurals. There’s a lot of different ways to do epidurals, and there’s a lot of different things we can accomplish with epidurals. If it makes sense based on your situation, we’ll talk through the range of options. Each provider approaches this methodologically differently. Almost like Michelin-star chefs will have a different recipe for apple pie. And not everyone’s apple pie is going to taste the same.
When we evaluate a patient, I really want to understand: what is it that we need to accomplish with an epidural, and how can I craft that epidural very specifically mechanically to accomplish what I want it to accomplish? Interesting add-ons with an epidural may include scar-dissolving medications. For a patient who’s had a prior surgery, I may do what’s called an epidurolysis procedure. This is where I can use a catheter to target areas of scar tissue and inject medication specifically to dissolve that scar tissue. Generally, this produces a more durable result than just popping steroid into the space.
We know with epidural steroid injections, the steroid is only effective in new-onset radiculopathy, meaning a new disc herniation causing sciatica-type pain. If this is an old disc herniation and there are adhesions from that disc sticking, or if there’s spinal stenosis, there’s actually no role for the steroid. There’s no benefit from the steroid in that situation, and just high-volume fluid, local anesthetic, and contrast by itself may be enough.
So when we’re looking at a patient who’s having any kind of nerve entrapment or pain from the disc-nerve interface in the back, we figure out, based on the imaging and based on their exam, what approach, what technique, what contents, and what volume are going to be the most effective for that patient.
Spine injections and epidurals are targeted procedures used to evaluate or reduce selected spine-related pain. They may be considered when symptoms are linked to irritated spinal nerves, nerve root inflammation, disc herniations, sciatica, spinal stenosis, or radiating arm or leg pain.
At 91视频, spine injections NYC care begins with diagnosis-first evaluation. The goal is to determine whether pain is coming from a spinal nerve, disc, facet joint, sacroiliac joint, muscle, ligament, hip, inflammatory process, hypermobility-related mechanics, or another pain generator before recommending an injection.
MPM specialists evaluate whether spine injections or epidurals may be appropriate by reviewing the patient鈥檚 symptoms, physical exam, imaging, pain distribution, neurological findings, prior treatments, and safety factors.
Neck and back pain can come from many sources, including disc herniations, sciatica, spinal stenosis, spondylosis, spondylolisthesis, scoliosis, arthritis, facet-mediated pain, SI joint dysfunction, peripheral nerve irritation, muscle guarding, hypermobility, or centrally amplified pain. This evaluation helps determine whether an epidural injection, SI joint injection, facet procedure, peripheral nerve block, medication management, epidural lysis of adhesions, spinal cord stimulation, surgical referral, or another pathway may be appropriate.
Patients often search for spine injections in Manhattan when neck pain, back pain, sciatica, radiating arm pain, radiating leg pain, disc herniation, or spinal stenosis has not improved with medication, physical therapy, chiropractic care, activity modification, or prior treatment. Epidural steroid injections may help reduce inflammation around irritated spinal nerve roots in selected cases, but they do not repair discs, reverse stenosis, or cure chronic spine pain.
MPM approaches spine injections and epidurals as part of a broader diagnosis-first spine care pathway. The correct injection depends on the suspected pain generator, symptom pattern, exam findings, imaging, prior treatment response, and patient safety profile. Temporary relief may be clinically useful because it can help confirm whether a targeted structure is contributing to pain and guide next steps in care.
Spine injections and epidurals fit within MPM鈥檚 Musculoskeletal issues, Hypermobility, and Complex Chronic Pain expertise because spine pain often involves overlapping mechanical, nerve, inflammatory, and nervous system factors. A patient may have a disc herniation, spinal stenosis, spondylosis, spondylolisthesis, scoliosis, arthritis, hypermobility-related mechanics, nerve irritation, or chronic pain sensitization.
MPM evaluates spine pain within the full clinical picture. An epidural injection may be helpful when symptoms and imaging match a nerve root pain pattern, but it may not address pain caused by SI joint dysfunction, facet joints, peripheral nerves, hip pathology, muscle guarding, or centralized pain. Treatment planning may include spine injections, medication management, rehabilitation, other targeted procedures, spinal cord stimulation, or surgical coordination when appropriate.
Before a spine injection or epidural, MPM reviews the suspected pain generator, imaging, neurological findings, medications, allergies, bleeding risk, medical history, risks, alternatives, and post-procedure instructions. Image guidance is commonly used for spine injections to support accurate placement and safety.
During the procedure, medication is placed near the targeted spinal nerve, epidural space, or other spine-related structure depending on the planned approach. Patients may feel pressure, brief discomfort, temporary numbness, soreness, or a short pain flare after the injection. Relief may occur quickly if local anesthetic is used, while steroid-related improvement may take longer. Some patients have temporary relief, some have longer relief, and some do not respond. MPM reviews the response to determine whether the target was clinically meaningful and what next step should be considered.
I cannot say enough good things about 91视频. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional 鈥� knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit 91视频 because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I鈥檝e suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I鈥檓 feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor鈥檚 office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at 91视频. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I鈥檓 finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Spine injections are targeted procedures used to evaluate or reduce selected spine-related pain. They may involve medication placed near spinal nerves, the epidural space, joints, or other spine-related structures depending on the diagnosis. At MPM, spine injections are recommended only after evaluating whether pain is nerve-root-related, disc-related, facet-mediated, SI joint-related, muscular, inflammatory, hypermobility-related, or coming from another source.
An epidural steroid injection places corticosteroid medication, often with local anesthetic, into the epidural space around the spinal nerves. It may be considered when inflammation or irritation around a spinal nerve root is contributing to pain. Epidural injections are commonly used for selected cases of sciatica, radiating arm or leg pain, disc herniation, or spinal stenosis. They do not repair discs or cure spine degeneration.
Epidural injections are intended to reduce inflammation around irritated spinal nerves. When nerve root inflammation contributes to pain, reducing that inflammation may decrease radiating pain, numbness, tingling, or nerve-related symptoms for a period of time. Relief varies by diagnosis, anatomy, medication used, and patient response. MPM uses the response to help guide the broader care plan.
Epidural injections may be considered for selected cases of disc herniation, sciatica, radiculopathy, spinal stenosis, radiating leg pain, radiating arm pain, and nerve root irritation. They may not be appropriate when pain is mainly caused by facet joints, SI joint dysfunction, hip pathology, muscle pain, peripheral nerve entrapment, inflammatory disease, or centralized pain. MPM evaluates the likely pain generator before recommending an epidural.
Epidural injections may help selected patients with sciatica when pain is related to irritation or inflammation of a spinal nerve root. This may occur with disc herniation, spinal stenosis, or other spine conditions. Relief may be temporary and varies by patient. If symptoms are caused by another source, such as SI joint dysfunction, hip pathology, piriformis-related pain, or peripheral nerve entrapment, another treatment may be more appropriate.
Spine injections may help selected patients when a herniated disc irritates or inflames a nearby spinal nerve root. An epidural steroid injection may reduce inflammation around the nerve and help improve symptoms for a period of time. It does not repair the disc or remove the herniation. MPM evaluates whether the imaging findings match the patient鈥檚 symptoms before recommending an injection.
Epidural injections may be considered for selected patients with spinal stenosis, especially when nerve compression or inflammation contributes to radiating leg or arm symptoms. Relief may be temporary, and results vary. Epidural injections do not reverse stenosis. Some patients may need physical therapy, medication management, activity modification, repeat evaluation, epidural lysis of adhesions, spinal cord stimulation, or surgical consultation depending on severity and function.
Epidural injections may help neck or back pain when symptoms are linked to irritated spinal nerves, especially when pain radiates into the arm or leg. They are less likely to help if pain is mainly muscular, facet-related, SI joint-related, hip-related, inflammatory, or centrally amplified. MPM evaluates the pain pattern and imaging before deciding whether an epidural or another procedure is more appropriate.
Interlaminar epidural injections place medication into the epidural space through the back of the spine. Transforaminal epidural injections target the area near a specific nerve root as it exits the spine. Caudal epidural injections access the epidural space through the lower sacral region. The best approach depends on the diagnosis, pain distribution, anatomy, imaging findings, prior surgery, and safety considerations.
Spine injections usually target spinal nerves, the epidural space, or spine-related structures. SI joint injections target the sacroiliac joint, which connects the sacrum and pelvis. SI joint pain can mimic sciatica, hip pain, or lower back pain, so the distinction matters. MPM evaluates whether symptoms are more consistent with nerve root irritation, SI joint dysfunction, facet pain, hip pathology, or another pain source.
Epidural spine injections are generally used when pain involves irritated spinal nerves or nerve roots. Facet injections or medial branch procedures are used when pain appears to come from the small joints in the back of the spine. The symptoms, exam findings, imaging, and pain pattern help determine which target is more likely. MPM does not treat all back pain with the same injection approach.
Relief varies by patient, diagnosis, medication used, severity of nerve irritation, and the underlying condition. Some patients experience relief for days or weeks, while others may have longer improvement. Some patients do not respond. Temporary relief can still be useful because it may help confirm that the targeted nerve or spine level is clinically relevant.
The number of epidural injections depends on diagnosis, response, medical history, steroid exposure, safety factors, and treatment goals. Repeated steroid injections are not appropriate for every patient and should be limited based on clinical judgment. MPM reviews the risks and benefits before recommending repeat injections and considers other options when relief is short-lived or incomplete.
Spine injections and epidurals are commonly performed with image guidance, such as fluoroscopy, to support accurate placement and improve procedural safety. The specific type of guidance depends on the procedure, anatomy, diagnosis, and safety considerations. Image guidance does not guarantee relief, but it helps confirm placement and supports safer procedural planning.
Risks may include pain flare, bruising, bleeding, infection, allergic reaction, temporary numbness or weakness, dizziness, vasovagal reaction, elevated blood sugar, steroid-related side effects, dural puncture headache, nerve irritation, rare neurologic injury, vascular injury, local anesthetic toxicity, incomplete relief, temporary relief only, or no relief. MPM reviews risks, medications, and safety factors before treatment.
Spine injections may not be appropriate when symptoms do not match a spine or nerve root pain pattern, when another pain generator is more likely, or when safety risks outweigh the potential benefit. They may also need to be delayed or avoided with active infection, uncontrolled bleeding risk, certain medication concerns, unstable neurological symptoms, or urgent red flags. MPM evaluates these factors before recommending an injection.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If you are considering spine injections in NYC for back pain, neck pain, sciatica, radiating arm or leg pain, disc herniation, spinal stenosis, nerve root pain, or complex spine pain, MPM can help determine whether an epidural or another targeted procedure may be appropriate. Your evaluation will consider your symptoms, imaging, exam findings, prior care, safety factors, and broader treatment goals before any recommendation is made.
Spine injections and epidurals are targeted procedures used to evaluate or reduce selected spine-related pain. They may be considered for neck pain, back pain, radiating arm pain, radiating leg pain, sciatica, disc herniations, spinal stenosis, nerve root irritation, and certain chronic spine pain patterns.
At 91视频 (MPM), spine injections NYC care begins with diagnosis-first evaluation. The goal is to determine whether the pain is truly coming from a spine-related structure before recommending an injection.
An epidural steroid injection places anti-inflammatory medication into the epidural space around the spinal nerves. It may be considered when a spinal nerve root is irritated or inflamed, often from disc herniation, spinal stenosis, or other spine conditions that affect nerve pathways.
The purpose is to reduce inflammation around the irritated nerve and potentially reduce radiating pain. Epidural injections may help selected patients with sciatica, lumbar radiculopathy, cervical radiculopathy, arm pain, leg pain, or nerve root irritation. They do not repair a herniated disc, reverse stenosis, correct scoliosis, or cure chronic spine pain.
Not all back or neck pain is epidural-type pain. Pain may come from a disc, spinal nerve, facet joint, SI joint, muscle, ligament, hip, peripheral nerve, inflammatory condition, hypermobility-related mechanics, or central pain sensitization. Some patients have more than one contributor at the same time.
This is why MPM reviews symptoms, neurological findings, imaging, exam results, prior treatment response, and functional impact before recommending a procedure. The correct target matters more than simply receiving a 鈥渂ack injection.鈥�
Different epidural approaches may be used depending on the diagnosis and anatomy.
Interlaminar epidural injections place medication into the epidural space through the back of the spine. Transforaminal epidural injections target the area near a specific nerve root as it exits the spine. Caudal epidural injections access the epidural space through the lower sacral region and may be considered in selected lower back or leg pain patterns.
The choice depends on the patient鈥檚 symptoms, MRI findings, prior surgery, anatomy, safety factors, and treatment goals. MPM determines the approach only after matching the procedure to the suspected pain generator.
Sciatica usually refers to pain that travels from the lower back or buttock into the leg. It may occur when a spinal nerve root is irritated or compressed. In selected cases, epidural steroid injections may help reduce nerve-related inflammation and improve symptoms for a period of time.
However, not all leg pain is sciatica from the spine. Similar symptoms may occur with SI joint dysfunction, hip pathology, piriformis-related pain, peripheral nerve entrapment, pelvic mechanics, vascular conditions, or central sensitization. MPM evaluates these possibilities before recommending a spine injection.
Spinal stenosis occurs when narrowing in the spine affects nearby nerves. Some patients develop neurogenic claudication, which may include leg pain, heaviness, numbness, or weakness with standing or walking. Epidural injections may provide temporary symptom relief for selected patients, but they do not reverse the narrowing.
If stenosis is severe or symptoms are worsening, additional evaluation may be needed. Treatment may include physical therapy, medication management, activity modification, injections, surgical evaluation, spinal cord stimulation in selected chronic pain cases, or other coordinated care.
Epidural injections are often considered when inflammation around an irritated spinal nerve may be contributing to pain. Epidural lysis of adhesions, sometimes associated with a Racz catheter, may be considered in selected cases when scar tissue or adhesions are suspected to contribute to persistent nerve pain, often after prior surgery or prolonged symptoms.
Spinal cord stimulation is a more advanced neuromodulation option that may be considered for selected chronic nerve-related pain patterns when conservative care and less invasive procedures have not provided enough relief. MPM uses the patient鈥檚 diagnosis, prior response, imaging, and treatment goals to determine whether any of these options should be discussed.
Relief after a spine injection can provide useful information. If pain improves in the expected region, the response may support the targeted spinal nerve or level as clinically meaningful. If relief is incomplete, very short-lived, or absent, another pain generator may be involved.
MPM reviews the timing, degree, and location of relief after the injection. This helps determine whether to repeat an injection, consider another target, adjust medication management, continue rehabilitation, evaluate for epidural lysis of adhesions, discuss spinal cord stimulation, or coordinate surgical evaluation when appropriate.
Spine injections and epidurals are medical procedures and should be selected carefully. Risks may include pain flare, bruising, bleeding, infection, allergic reaction, temporary numbness or weakness, dizziness, vasovagal reaction, elevated blood sugar, steroid-related side effects, dural puncture headache, nerve irritation, rare neurologic injury, vascular injury, local anesthetic toxicity, incomplete relief, temporary relief only, or no relief.
Patients should seek urgent evaluation for new or worsening weakness, bowel or bladder dysfunction, saddle anesthesia, fever, severe back pain after trauma, unexplained weight loss, cancer-related red flags, severe infection symptoms, sudden severe headache after injection, chest pain, shortness of breath, severe allergic reaction, or rapidly worsening symptoms.
For selected patients, spine injections and epidurals may be an important part of a diagnosis-first care plan. MPM鈥檚 role is to determine whether the pain pattern, imaging, exam, and safety profile support an injection and how the response should guide the next step in care.
