Epidural Steroid Injections

Epidural Steroid Injections are an effective adjunct to treatment for patients with pain of spinal origin. Commonly, nerves in the neck or back are compressed or irritated near the spine by a bulging or herniated disc, a bone spur, or scar tissue. This causes the nerve to become swollen, causing pain, numbness, tingling or weakness in the arms or legs. The purpose of the epidural injection is to decrease inflammation and provide pain relief, thereby facilitating active rehabilitation. Their primary use is as one component of a comprehensive treatment plan that includes medication, physical therapy, and education in body mechanics. For relief of pain, epidural steroid injections have a success rate of 75-85% in the short term. Long term relief is variable and appears to depend on compliance with treatment plan and back-sparing activities of daily living.

There are two approaches to the epidural space: interlaminar and transforaminal (also known as selective nerve root block). Depending on the location of the problem, your physician will select the approach with higher likelihood of relieving your problem.

Any procedure carries an inherent risk. These are minimized by using fluoroscopic (X-ray) guidance, sterile technique, and avoidance of medications that increase bleeding. However, infection, bleeding, allergic reactions to medications or contrast dye, vasovagal reaction (ie. fainting), spinal headache, nerve injury, or temporary increase in pain, although rare, are possible.

The procedure is performed while lying on an x-ray table. One may have an intravenous line inserted to provide sedation. The injection site is anesthetized through a very thin needle. The epidural needle is slowly advanced into the epidural space under x-ray guidance. Once the space is identified, contrast dye is injected for confirmation of placement and the medication (cortisone with/without anesthetic) is slowly injected. The entire procedure usually takes less than 10 minutes.

After the procedure, one may notice a decrease or disappearance of pain and may feel a mild numbness, tingling or heaviness in the leg or arm. This effect is due to the anesthetic and is transient. After monitoring for 20-30 minutes and receiving something to eat and drink, you will be allowed to walk with a nurse. Once the staff determines you are stable, you will be discharged with written instructions.

Over the next few hours, as the local anesthetic wears off, pain may return, although frequently not to the level it was before, and discomfort at the injection site may be noted. The anti-inflammatory effects of the steroid can take 2-4 days to take effect. It may take that long to help your pain. You should see your doctor 5-10 days after the injection to discuss your progress and future therapy. If pain relief is not complete, the injection can be repeated after two weeks. Your doctor may select the same or a different approach to the epidural space. If no relief is appreciated after 3 injections, it is not usually continued.

Preparing for an Epidural

If you are on any blood thinners (Coumadin, Plavix, Aggrenox, Aspirin), are taking any anti-inflammatory medicines, have any disorders of blood clotting, or have any questions regarding medications to take, please discuss it with the doctor.

Do not eat or drink after midnight the day prior to injection if sedation is contemplated. You may eat a light breakfast if you are sure you are not receiving any sedation.

Regular medications should be taken with a sip of water the morning of the procedure. If you are taking medications for diabetes, please consult with your doctor for instructions.

You should not drive after the procedure. Please arrange for transportation. Prepare to spend around 1 1/2 to 2 hours.

Do not plan on working or traveling the day of the procedure.