Lumbar Epidural Steroid Injections in Dubai
Who you'll see
Dr Sherief Elsayed
Consultant Spinal Surgeon, FRCS (Tr & Orth), UK-trained
Medically reviewed by Dr Sherief Elsayed, UK-trained Consultant Spinal Surgeon, FRCS (Tr & Orth). Last reviewed 14 October 2026.
A lumbar epidural steroid injection is offered for leg pain caused by an irritated nerve in the lower back, usually from a disc prolapse. This page explains when it is worth considering, how the approaches differ, and what the research shows. Dr Elsayed performs these injections and also operates on the same conditions.
At a glance
- The evidence is stronger for leg-dominant pain (sciatica) than for back pain alone, and even for sciatica the average benefit is small and short term (Oliveira et al., Cochrane review, 2020).
- Epidurals are aimed at leg pain rather than back pain alone. NICE advises considering one for acute and severe sciatica (NICE NG59, recommendation 1.3.5).
- New numbness between the legs, or new bladder or bowel problems, need emergency care.
What is an epidural steroid injection?
The epidural space is a thin layer just inside the spinal canal, around the sac that holds the nerves. When a disc prolapse or narrowing presses on a nerve root, the nerve becomes inflamed and sends pain down the leg: radicular pain, or sciatica.
The injection places a corticosteroid, usually mixed with local anaesthetic, around the irritated nerve. The local anaesthetic wears off within hours; the steroid aims to calm the inflammation. Neither removes a disc or widens a narrowed canal. The aim is to reduce pain so that you can move, sleep and do your rehabilitation while the nerve settles.
Who it may help, and who it is unlikely to help
Leg pain from a disc prolapse (sciatica)
The evidence for this use is stronger than for the others below. NICE advises considering an epidural of local anaesthetic and steroid for people with acute and severe sciatica (NICE NG59, recommendation 1.3.5). The typical candidate has pain worse in the leg than the back, following one nerve and matching the MRI scan.
Even so, the benefit is modest. A Cochrane review of 25 placebo-controlled trials, with 2,470 participants, found that epidural steroids probably reduce leg pain and disability slightly for up to 3 months, and that the average effect may be too small for many patients to consider important (Oliveira et al., 2020). Some people improve clearly and others notice little change, and nobody can reliably predict which.
Spinal stenosis
Stenosis is a narrowing of the spinal canal. Its typical symptom, neurogenic claudication, is heaviness or aching in both legs on walking, eased by sitting or bending forward. Here the evidence is disappointing. In a trial of 400 people with central stenosis, adding steroid to local anaesthetic gave minimal or no extra benefit at 6 weeks (Friedly et al., 2014).
Pain down one leg from a single nerve trapped at the side of the canal behaves more like sciatica, and an injection may be discussed in that situation.
Back pain without leg pain
Epidurals are aimed at leg pain, and the trials above studied people with leg pain. For back pain alone, other injections are used. Where the facet joints are the likely source of chronic back pain, NICE supports a different route: a test block of the nerves to those joints (a medial branch block), then radiofrequency denervation if it confirms them as the main source (NICE NG59, recommendations 1.3.2 and 1.3.3). See spinal injections and back pain treatment in Dubai.
When an epidural may not be safe
Please mention these when you book; the injection may need to be postponed, adapted or avoided.
- Infection near the injection site or elsewhere in the body, including a fever.
- Blood thinners or a bleeding disorder. These raise the risk of bleeding in the spinal canal. Guidance sets out which drugs to pause and for how long (Narouze et al., 2018). Any pause is agreed case by case with your prescribing doctor; never stop one on your own.
- Diabetes. The steroid raises blood sugar for a short time, so check it more often for a few days. The injection may be postponed if control is poor.
- Pregnancy or breastfeeding. X-ray-guided injections are usually avoided in pregnancy. If you are breastfeeding, this is discussed at your consultation.
- Allergy to local anaesthetic, steroid, X-ray contrast dye or latex. Safety guidance allows an interlaminar injection without contrast after a documented contrast allergy (Rathmell et al., 2015).
- A weakened immune system, or recent steroid tablets or injections.
Interlaminar, caudal and transforaminal: the three approaches
All three reach the epidural space by different routes, and Dr Elsayed performs all three. The choice depends on the level of the problem, whether one or both legs are affected, and any previous surgery.
Interlaminar epidural
The needle passes between two vertebrae at the back of the spine, at or near the level of the problem. Safety guidance recommends X-ray guidance and a test dose of contrast dye for every lumbar interlaminar injection (Rathmell et al., 2015).
Caudal epidural
The needle enters through the sacral hiatus, a small opening just above the tailbone, below where the dural sac usually ends. The route is useful after previous back surgery, when scar tissue can make the interlaminar route harder. The medicine travels upwards, so a larger volume is used and it mainly reaches the lowest nerves.
| Interlaminar | Caudal | Transforaminal | |
|---|---|---|---|
| Route | Between two vertebrae at the back | Base of the spine, above the tailbone | Beside one nerve root as it leaves the spine |
| Often chosen for | Disc prolapse at one level | Lowest levels, both legs, previous surgery | One identified nerve; also a diagnostic test |
| Note | Dural puncture slightly more likely than with transforaminal (see risks) | Larger volume needed | Close to small arteries; non-particulate steroid advised first |
Transforaminal epidurals and nerve root blocks
A transforaminal injection places the needle beside a single nerve root at the foramen, the opening where it leaves the spine. With local anaesthetic alone it can test which nerve is causing the pain (a selective nerve root block), which helps plan surgery. Safety guidance recommends a non-particulate steroid such as dexamethasone for the first lumbar transforaminal injection (Rathmell et al., 2015). Dr Elsayed performs these in the lower back.
What happens on the day
Injections are performed at American Hospital Dubai as a day procedure. Timing and any fasting instructions are given when you book.
- Before: follow the blood-thinner and diabetes instructions agreed at your consultation. The risks and alternatives are explained again and you sign a consent form.
- Positioning and numbing: you are positioned on the X-ray table, the skin is cleaned, and local anaesthetic is injected, which stings briefly.
- Guidance and injection: X-ray (fluoroscopy) images guide the needle, and contrast dye confirms the spread before the medicine is injected. You may feel pressure or a brief, familiar leg pain. The steroid and dose are decided at your consultation.
- Sedation: light sedation is available on request, but safety guidance advises against moderate or heavy sedation, so that you can report any unusual sensation (Rathmell et al., 2015). Diagnostic test blocks are never done under sedation.
- Recovery: you rest for a short time while staff check you, then go home.
Aftercare
- Your legs may feel numb or heavy for a few hours. Do not drive that day; arrange for someone else to drive you home.
- Move gently, and if your pain eases, use that window to progress your physiotherapy. Return to exercise and work is discussed at your consultation.
- If you have diabetes, check your blood sugar more often for the next few days.
- Note your leg pain daily for the following weeks; it helps decide the next step.
- Follow-up is arranged at your consultation.
Risks and side effects
In 16,638 image-guided epidural injections at three academic centres, there were no major nerve injuries or bleeding complications, and side effects were mostly minor and short-lived (El-Yahchouchi et al., 2016). Most were transforaminal (1,682 were interlaminar), and none were caudal.
Common or short-lived
- Leg numbness or heaviness for a few hours, and soreness at the injection site.
- A temporary increase in pain, reported by 1.8% of patients after an interlaminar injection (El-Yahchouchi et al., 2016).
- Flushing, sleeplessness or headache from the steroid: 2.6% of patients (El-Yahchouchi et al., 2016).
- Fainting or feeling faint: 0.5% of interlaminar injections (El-Yahchouchi et al., 2016).
- In people with diabetes, a rise in blood sugar, which settled within about 2 days in a study of 30 patients (Even et al., 2012).
- Irregular periods (Oliveira et al., 2020).
Uncommon
- Dural puncture, in 0.2% of interlaminar injections (El-Yahchouchi et al., 2016). It can cause a headache that is worse upright and eases lying flat; occasionally a blood patch is needed.
Rare but serious
- Infection, including an epidural abscess or meningitis.
- Bleeding that presses on the nerves (an epidural haematoma), more likely with blood thinners.
- Nerve injury causing lasting pain, numbness or weakness.
- Very rarely, stroke, spinal cord injury, paralysis or death. In 2014 the US Food and Drug Administration (FDA) required a warning about these events; no injectable steroid is approved for epidural use, so this use is off-label. All the catastrophic cases reported to the FDA involved particulate steroid suspensions (Racoosin et al., FDA, 2015).
What to expect: the evidence in plain terms
- If it helps, the benefit is mainly in the short term, up to 3 months (Oliveira et al., 2020), and on average small and not sustained (Chou et al., 2015).
- It does not reliably prevent surgery. Epidurals for sciatica were linked with fewer operations in the short term but not in the long term (Chou et al., 2015).
- Repeat injections: there is no agreed, evidence-based maximum. Repeats are spaced out, limited and decided case by case: how much the first helped, for how long, and the total steroid dose over time all matter.
Alternatives, and when surgery is considered
Many episodes of sciatica settle without any procedure. Options include physiotherapy, pain-relieving medicines, a transforaminal injection when one nerve is clearly responsible, and surgery. NICE advises considering decompression for sciatica when non-surgical treatment has not improved pain or function and the scan matches the symptoms (NICE NG59, recommendation 1.3.8). Progressive leg weakness may call for earlier surgery.
As Dr Elsayed performs both injections and surgery, he can set out the trade-offs at one consultation. See sciatica, herniated disc and spinal stenosis.
Symptoms that need urgent care
Call 998 (UAE ambulance) or go to the nearest emergency department straight away if you develop:
- numbness between the legs, or around the genitals or back passage;
- new difficulty passing urine, loss of bladder or bowel control, or new loss of sexual function;
- sciatica in both legs, or leg weakness that is getting worse.
These can be signs of cauda equina syndrome. After an epidural, also seek urgent advice for fever, redness at the injection site with increasing back pain, numbness or weakness that does not wear off, or a severe headache when upright.
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Your consultation with Dr Sherief Elsayed
Dr Sherief Elsayed is a UK-trained Consultant Spinal Surgeon, FRCS (Tr & Orth). In the lower back he performs interlaminar, caudal and transforaminal epidurals and selective nerve root blocks; he also performs facet joint injections, medial branch blocks, radiofrequency denervation (RFA) and sacroiliac joint injections, as well as spinal surgery. An MRI is usually needed before an epidural; he will examine you, review your MRI or arrange one, then advise whether an injection is worthwhile and which approach suits you.
He sees patients at OrthoPro Clinic, Dubai Science Park, and at UPANDRUNNING on Al Wasl Road; injections are performed at American Hospital Dubai. To book, call OrthoPro Clinic on 04 835 9000, send a WhatsApp message to 052 105 2798, or use the contact page. Fees depend on the procedure and your insurance; OrthoPro reception can check your cover and any pre-approval.
Frequently asked questions
Epidurals are aimed at leg pain from an irritated nerve (sciatica). For back pain alone, other treatments are used; where the facet joints are the source, a test block then radiofrequency denervation may be considered.
It varies. In trials the average benefit was modest and mainly seen up to 3 months (Cochrane review, 2020).
No. A labour epidural gives anaesthetic continuously through a fine tube. A steroid epidural is a single injection aimed at an inflamed nerve, and you go home the same day.
The skin is numbed first, so most people feel a brief sting, then pressure. You stay awake; light sedation is available on request, except for diagnostic test blocks.
Not on the day: someone else should drive you home. Return to work is discussed at your consultation.
There is no agreed maximum. Repeats are spaced out, limited and decided case by case, taking the total steroid dose over time into account.
Not reliably. A 2015 systematic review (Chou et al.) linked epidurals for sciatica with fewer operations in the short term only.
Often, with planning. Check your blood sugar more often for a few days; the injection may be postponed if control is poor. Blood thinners are managed case by case with your prescribing doctor; never stop one on your own.