Elective spinal injections should be performed with imaging guidance, such as fluoroscopy or the use of a radiocontrast agent , unless that guidance is contraindicated.  Imaging guidance ensures the correct placement of the needle and maximizes the physician's ability to make an accurate diagnosis and administer effective therapy.  Without imaging, the risk increases for the injection to be incorrectly placed, and this would in turn lower the therapy's efficacy and increase subsequent risk of need for more treatment.  While traditional techniques without image guidance, also known as "blind injections", can assure a degree of accuracy using anatomical landmarks, it has been shown in studies that image guidance provides much more reliable localization and accuracy in comparison.
You will lie on your stomach on a procedure table with pillows positioned for optimal comfort. After the back area is prepped with special soap, local anesthetic numbing medicine will be injected over a small area of the skin, which may sting for a few seconds. Next, a special needle will be inserted and guided via X-ray to the epidural space. Dye is then injected to confirm proper location into the epidural space. Finally, the healthcare provider injects the medication (such as a steroid or anesthetic). You may feel pressure in the back or down the leg as the medication is injected.