Epidural Steroid Injections
Epidural steroid injections (ESI) help us treat irritated spinal nerve roots that cause pain in your neck, shoulders, arms, upper and lower back, buttocks, or legs. Many conditions can cause this type of pain, such as herniated discs, degenerative disc disease, and arthritis.
An epidural steroid injection (ESI) is the delivery of powerful anti-inflammatory medicine directly into the space outside of the sac of fluid around your spinal cord. This area is called the epidural space. We perform ESI procedures to help reduce inflammation and relieve pain. The injection may comprise steroids that inhibit the production of painful inflammatory substances and/or a lidocaine or saline solution to help flush out inflammatory proteins from around the affected area.
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Procedure Benefits
The long-acting steroid that is injected reduces the inflammation and swelling of spinal nerve roots and other tissues surrounding the spinal nerve root. This may in turn reduce pain, tingling and numbness and other symptoms caused by such inflammation, irritation, or swelling.
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It is sometimes difficult to predict if the injection will help you or not. Patients who have pain radiating from the spine down into the arms or legs respond better to the injections than patients who have only pure neck or back pain. Similarly, patients with a recent onset of pain may respond much better than patients with longstanding pain.
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Length of Pain Relief
The steroid starts working in about 3 to 5 days and the effect can last for several days to several months with some cases lasting for several years.
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Epidural Steroid Injection Procedure Process
The procedure is performed in different positions depending on the area treated. They are done either with the patient laying on their side or back for most neck injections and with the patient typically on their stomach for back injections. Occasionally other positions are used to optimize the procedure or image guidance. The skin overlying the treatment area is cleaned with antiseptic solution and numbed with local anesthetic. The injection needle is then placed under live fluoroscopy (imaging) guidance. Once the needle is in the correct location, the medication will be injected which can often feel like the normal pain that the patient feels in the distribution of that particular spinal nerve root. The needle is then removed and a sterile bandage is applied.
Amount of Time for the Procedure
Depending on the area to be treated, the actual procedure typically takes five to fifteen minutes.
Preventing Procedural Pain
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The procedure involves inserting a needle through skin and deeper tissues which can sometimes be painful. We do numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the spinal needle. Once numbed, placing the spinal needle often feels like more of a strong pressure and pinching than a sharp pain. Some patients choose to receive intravenous sedation that can make the procedure easier to tolerate. Many patients choose to undergo the injection without sedation and do well with very little pain throughout the procedure.
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IV Sedation as an Option
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This procedure is done under local anesthesia only, or with the assistance of a anesthesia provider using IV medications providing light sedation. The sedation can make the procedure more tolerable for some patients. The amount of sedation given generally depends upon the patient. Some patients have enough sedation that they have amnesia and might not remember parts or all of the actual procedure.
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What to Expect After the Epidural
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Immediately after the injection, you may feel like your arm or leg is heavy and may be numb, depending on where the injection was done and how much local anesthetic was used. You may notice that your pain may be less immediately following the procedure. This immediate effect is also due to the local anesthetic injected. This will last only for a few hours. Your pain may return and you may have some soreness, worsening pain, or aching for a a few days following. This is due to the mechanical process of the needle insertion, as well as the irritation from the steroid injected. Typically, you should start obtaining pain relief starting the third to fourth day.
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Post-Procedural Care
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Due to the possibility that there may be numbness or weakness in the extremity treated, it may make driving following the procedure both difficult and dangerous. All patients must have a ride home prior to undergoing the procedure. Most patients are advised to take it easy for a day or so after the procedure until the medication has a chance to work. Typically you can perform any activity that you were able to perform before the procedure without further limitations.
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Returning to Work After the Procedure
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You should be able to go back to work the next day. Usually you will feel some soreness or aching at the injection site only.
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Procedure Risks and Side Effects
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Generally speaking, injections are safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is pain from the actual injection once the local anesthetic wears off and this pain is temporary. Uncommon risks involve spinal puncture, infection, bleeding inside the epidural space, nerve damage, or worsening of symptoms. Other risks which are related to the side effects of the long acting steroid include weight gain, increase in blood sugar in diabetics, water retention and suppression of body’s own natural production of steroids when steroids are overused