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Epidural Steroid Injections

 

What are epidural steroid injections?

An epidural steroid injection (ESI) is a minimally invasive procedure that can relieve neck, arm, back, and leg pain caused by inflamed spinal nerves. ESI may be performed to relieve pain caused by spinal stenosis, spondylolysis, or disc herniation.

An epidural steroid injection is delivered to the spinal nerve through the epidural space – the area between the protective covering of the spinal cord and vertebrae. This area is filled with fat and small blood vessels. Medicines includes both a long-lasting corticosteroid and an anesthetic agent. Corticosteroid injections can reduce inflammation and can be effective when delivered directly into the affected area. Unfortunately, the injection does not make a herniated disc smaller; it can only work on the spinal nerves.  The pain relief can last from days to years, allowing you to improve your spinal condition.

Causes for an Epidural Steroid Injection

Patients with pain in the neck, arm, low back or leg may benefit from ESI. Specifically, people with the following conditions:

  • Spinal stenosis – narrowing of the spinal canal and nerve root canal causing leg pain.
  • Spondylolysis --- weakness or fracture between upper and lower facets of the vertebrae.
  • Herniated disc – occurs when the gel-like material within the disc bulges or ruptures through a weak area in the surrounding wall, causing irritation, pain and swelling.
  • Degenerative disc – breakdown or again of the intervertebral disc causing collapse of the disc space, tears in the annulus and growth of bone spurs.
  • Sciatica – pain that travels along the sciatic nerve in the buttocks and down the legs. Typically caused by the compression of lumbar or spinal nerves.

ESI has proven helpful for some patients in the treatment of the above painful inflammatory conditions. ESI can also help determine whether surgery might be beneficial for pain associated with a herniated disc. When symptoms interfere with rehabilitative exercises, epidurals can ease the pain enough so that patients can continue their physical therapy. 

ESI should not be performed on people who have an infection, are pregnant, or have bleeding problems. It may slightly elevate the blood sugar levels in patients with diabetes, typically for less than 24 hours. It may also temporarily elevate blood pressure. 

How do I know if an epidural steroid injection is right for me?

Your healthcare provider will perform a physical exam and review any previous imaging to plan the best approach for the injections. Patients who take blood thinner medications may need to stop taking it 3-5 days prior to the ESI. Discuss any other medications with your provider, as well as if you think you may be pregnant or plan to become pregnant as certain medications can be harmful.

What happens during an epidural steroid injection?

During the ESI, your provider will use a type of imaging guidance called fluoroscopy to help guide the epidural needle to exactly the right position. They then will inject a local anesthesia near the area where the epidural will be inserted. When the epidural needle is in place, your provider will inject a contrast material that ensures the needle tip is in the epidural space and not in a blood vessel or other tissue. Then, they will slowly inject the steroid into the epidural space around your spinal cord.

You will likely experience a minor pinch when your provider injects the anesthetic. You may not feel anything during your ESI, or you may feel the following:

  • Pressure
  • Tingling
  • Burning
  • Temporary pain

Are there risks or side effects with ESI?

Your pain may become worse for two or three days following your ESI before it begins to improve. Other side effects you may experience include:

  • Temporary increase in pain while the medication begins to work.
  • Tenderness and bruising at site of injection.
  • In diabetics, an ESI will likely cause high blood pressure.

Epidural steroid injections are usually safe, but there are certain side effects and complications that may be associated. Although they are rare, they can include:

  • Low blood pressure
  • Severe headache caused by spinal fluid leakage.
  • Infection
  • Negative reaction to medications.
  • Possible bleeding
  • Damage to nerves at injection site.
  • Temporary loss of control of your bladder.

Although it is rare, some ESI can lead to long-term complications, including:

  • Permanent neurologic damage due to nerve damage.
  • Chronic pain due to spinal cord or nerve root damage.
  • Permanent paralysis from hematoma.

What is the recovery from ESI like?

Recovery and effectiveness from ESI will vary from person to person. Many people experience temporary pain relief from ESI, some even experiencing relief for up to 12 months. However, some people may not experience pain relief at all. 

If a lumbar ESI works for you and results in pain relief, your provider may recommend another injection later on. However, most providers limit patients to 2-3 ESIs per year due to possible complications.

It is important to follow your provider’s instructions to avoid complications. Contact your provider right away if you experience any of the following:

  • Severe headache when standing or sitting.
  • Fever
  • Reduced or complete loss of bladder or bowel control.
  • Numbness or weakness in legs.