Epidural Steroid Injection

What is it?

Epidural steroid injections are one of the most common non-surgical treatment options for acute/chronic back/neck with arm/leg pain. Epidural steroid injections (ESIs) have been commonly used in the treatment of low back and leg pain since 1952 and is still an essential part of non-surgical treatment of sciatica and other low back pain problems.  A epidural steroid injection  delivers steroid medication in the area of spinal nerve roots that reside in the painful region, in order to provide relief. 

Back and neck pain can be caused by a bulging/herniated disc, arthritic bone spurs, lumbar spinal stenosis, degenerative disc disease, synovial cyst or annular tear within the disc.  Any condition or injury that causes nerve root irritation and inflammation can lead to lower and neck pain and referred pain from irrated  nerve roots. A common example of referred pain from general compression or irritation of the lumbar nerve roots is a condition known as sciatica.

An epidural injection can be performed in your cervical, thoracic, or lumbar spine to provide pain relief and relieve nerve swelling and inflammation. Epidural injections are a minimally invasive procedure that can deliver pain relief and allow patients to improve their function and become active again.

Managing  Pain with Epidural Steroid Injection

Pain that emanates from compressed or irritated nerves of the lower back can be managed with lumbar epidural steroid injections. This type of injection delivers a steroid medication (‘cortisone’) mixed with a local anesthetic into the epidural space. The epidural space is the fat filled ‘sleeve’ that surrounds and provides cushioning for the spinal cord and nerve roots.  
As opposed to oral steroids and painkillers, steroid injections can deliver very potent anti-inflammatory medication directly to the source of pain. This method provides a more targeted and powerful impact on symptoms with less overall side effects. Additionally, an ESI can help with “flushing out” inflammatory proteins and chemicals from the area that may be contributing to or exacerbating pain.  
Although lumbar epidural steroid injections do not eliminate the underlying condition, they do provide enough pain relief to allow the patient to move forward with their rehabilitation program. Breaking the cycle of inflammation and pain allows the body to compensate and improve function. For this reason, the benefits of the injection often outlast the effects of the steroid medication itself.An epidural injection is placed by the injured disc to relieve inflammation and pain of the affected nerve. 

By volume, what is injected consists mostly of sterile saline (salt water), a nerve numbing agent (local anesthetic) and a very small amount of potent anti-inflammatory (steroid). An epidural injection can help heal the injured nerve. An epidural does not heal a torn (herniated) disc. That will either heal on its own or may require surgery if it does not.  

Before the Procedure

The potential side effects of an ESI include, but are not limited to:

• Infection
• Bleeding
• Spinal headache
• Temporary leg weakness or numbness

Before the procedure:

• Let us know if you have a bleeding disorder or if you are using blood thinners such as aspiring, Coumadin (warfarin), Plavix (Clopidigel), Ticlid (ticlopidine), heparin, Lovenox (enoxaparin), Fragmin (dalteparin), Aggrenox (dipyridamole), or NSAIDS (such as ibuprofen, naproxen, celebrex, meloxicam), or any herbal bloodthinning medications.
• Stop Aspirin or Plavix 7 days prior to your procedure
• Stop Eliquis or Xarelto 3 days prior to your procedure
• Stop Aleve or Motrin 3 days prior to your procedure
• Stop fish oil 7 days prior to your procedure

During Procedure

Injections are performed sterilely in our fluoroscopy suite using live image guidance. You will be comfortably positioned with your face down. If you would like sedation, please ask your physician. The skin over the site to be injected with be sterilely cleaned. Local anesthesia will be used to numb the skin. The epidural needle will be placed under live fluoroscopic guidance. Once the needle is in place a steroid medication will then be administered, and needles removed. Bandages will be placed, and you will be taken to the recovery room until you are ready for discharge home.

What Happens after an injection?

You will be monitored for a short period of time.  Take it easy for the rest of the day.  You may feel immediate relief and numbness in your back and leg for a period of time after the injection.  This may indicate the medication is in the right area.  Your pain will return after this short period of pain relief.  However, it is also very common that your pain may actually worsen because of irritation from the needle or from the steroid medication itself.  

When will I get pain relief?

An epidural steroid injection can potentially reduce the chemical irritants in the epidural space and reduces inflammation of the nerve root, and it will take time to heal. Typically, patients experience pain relief in three to seven days, although in some cases it can be up to 14 days. The amount of relief is dependent upon the amount of inflammation, severity of the nerve compression and duration of the chronic pain.  Unfortunately, the longer patients have had their pain the more difficult it is to treat. Pain relief can be complete with one treatment, or it may require a subsequent injection. The duration of relief usually depends on the health of the disc, the severity of the injury and amount of arthritis. If after a series of injection is not helpful, then your physician may recommend a referral to a surgeon for surgical options.

• Other Treatments

• Conservative Therapy
• Epidural Steroid Injection
• Joint Injection
• Lumbar Radiofrequency Ablation (RFA)
• Medial Branch Block
• MLS Laser Therapy
• Peripheral Nerve Stimulation
• Regenerative Therapy
• Sacroiliac Injection (SI)
• Spinal Cord Stimulation For Diabetic Foot Pain
• Sympathetic Nerve Block
• Trigger Point Injection