Epidural Steroid Injection Injuries – Malpractice or Risk?

What Are Epidural Steroid Injections?

Epidural steroid injections (ESIs) are among the most commonly performed pain management procedures in the United States. They deliver a corticosteroid—typically triamcinolone, methylprednisolone, or dexamethasone—directly into the epidural space surrounding the spinal cord and nerve roots, where it reduces inflammation and can provide substantial relief for conditions such as herniated discs, spinal stenosis, and radiculopathy (nerve root pain).

When performed correctly by a trained physician under fluoroscopic (real-time X-ray) guidance with appropriate patient selection and sterile technique, ESIs are generally safe and effective. But like any invasive spinal procedure, they carry real risks—and when the procedure is performed negligently, those risks can materialize into catastrophic, permanent injuries.

Recognized Risks vs. Negligent Practice

The central question in any ESI malpractice case is whether the injury resulted from a known and accepted risk of the procedure—or from a departure from the standard of care. These are fundamentally different things under Texas law.

The Standard of Care for Epidural Steroid Injections

The standard of care for ESIs is defined by published guidelines from the American Society of Interventional Pain Physicians (ASIPP), the American Society of Anesthesiologists, and other specialty organizations. Key requirements include:

• Use of fluoroscopic or ultrasound guidance for accurate needle placement
• Contrast injection to confirm epidural spread and exclude intravascular positioning before injecting steroid
• Selection of non-particulate steroids (such as dexamethasone) for transforaminal cervical injections to reduce risk of vascular injury
• Sterile technique throughout the procedure
• Pre-procedure patient evaluation to identify contraindications
• Post-procedure monitoring for adverse reactions and documentation of the patient's neurological status

How These Cases Are Proven

ESI malpractice cases require expert testimony from a physician in the same or similar specialty—typically an interventional pain medicine physician, physiatrist, anesthesiologist, or neurosurgeon—who can explain what the standard required and how the defendant failed to meet it.

Procedure records, fluoroscopy images, contrast injection documentation, and post-procedure notes are key evidence. In cases involving infection, microbiology records, sterilization logs, and facility records may be central. For cases involving neurological injury, MRI findings and neurology consultation records help establish the injury and its temporal relationship to the procedure.

Texas-Specific Context

Texas's ESI malpractice cases can involve both individual physicians and pain management clinics or ambulatory surgery centers as institutional defendants. Depending on how the physician was employed, the hospital or clinic may be jointly liable.

The Texas Medical Liability Act requires a qualified expert report within 120 days of filing suit. In injection injury cases, an expert in interventional pain medicine is typically required—a general physician's opinion about the standard of care for a specialized spinal procedure may not be sufficient to satisfy Chapter 74.