Silver Spring Medical Center, LLC

Epidural Steroid Injections

Precision-guided steroid delivery into the epidural space to reduce nerve inflammation and alleviate radicular pain — performed by Tzvi Grossman, MD under real-time fluoroscopy.

What Is an Epidural Steroid Injection?

An epidural steroid injection (ESI) delivers a targeted combination of corticosteroid and local anesthetic directly into the epidural space — the area surrounding the spinal cord and nerve roots. By reducing inflammation at the source, ESIs can provide significant, often prolonged, relief from neck, mid-back, and low back pain that radiates into the arms or legs.

At Silver Spring Medical Center, all epidural steroid injections are performed by Tzvi Grossman, MD using real-time fluoroscopic (X-ray) guidance to ensure accurate needle placement, contrast confirmation, and optimal medication distribution.

Interlaminar Approach

The needle is advanced in the midline between two adjacent laminae, delivering medication broadly within the epidural space. Preferred when bilateral or diffuse coverage is desired. Commonly used in the lumbar and cervical regions.

Transforaminal Approach (Selective Nerve Root Block)

The needle is directed through the neural foramen to target a specific nerve root at its exit from the spinal canal. This approach offers more targeted delivery and is particularly valuable for unilateral radiculopathy with a clear dermatomal pattern.

Spinal Levels Treated
  • Cervical (C3–C7): arm pain, neck radiculopathy
  • Thoracic (T1–T12): mid-back pain, intercostal neuralgia
  • Lumbar (L1–L5): low back pain, sciatica, leg pain
  • Lumbosacral (L5–S1): buttock and posterior leg pain
Conditions Addressed
  • Disc herniation with radiculopathy
  • Spinal stenosis (central or foraminal)
  • Degenerative disc disease with referred pain
  • Post-laminectomy syndrome
  • Spondylolisthesis-related nerve compression
Why Fluoroscopy Guidance Matters
  • Real-time contrast confirmation of epidural spread
  • Avoidance of intravascular, intrathecal injection
  • Precise level and laterality targeting
  • Reduced risk of failed placement
What to Expect
  • Outpatient procedure: 20–40 minutes total
  • Minimal sedation or none required
  • Series of 1–3 injections, spaced 2–4 weeks apart
  • Relief may begin within 3–7 days
  • Effects can last weeks to several months

Procedure Protocol — Dr. Grossman's Approach

All injections are performed under sterile conditions in our fluoroscopy-equipped procedure suite. After positioning and skin prep, the target level is confirmed under live X-ray. Local anesthetic is administered for patient comfort, followed by fluoroscopy-guided needle advancement. Contrast dye is injected to confirm epidural spread and rule out intravascular placement. The corticosteroid and anesthetic mixture is then delivered under direct visualization.

  • Contrast confirmation required before every injection
  • Digital fluoroscopic images archived for each case
  • Post-procedure monitoring prior to discharge
  • Detailed follow-up within 2–4 weeks to assess response