What is an epidural steroid injection?

Certain steroid drugs (drugs related to cortisone) possess strong anti-inflammatory properties.  When injected around the irritated nerve, disc, or ligament, these drugs stop inflammation and relieve pain.  To place this medicine as close as possible to the site of the inflammation, it is often injected into the region of the spine called the epidural space.

What is the Epidural Space?

This space lies inside the spine between the inner surfaces of the bones of the spinal canal and the membrane covering the spinal cord.

Who is a good candidate for an epidural injection?

In some patients, irritation or pressure occurs on an individual spinal nerve.  This irritation can cause pain and numbness or tingling in the head, neck, arms, legs or buttocks, depending on the level of spinal nerve involvement.  Patients with a recent onset of pain may respond better than those with long-standing pain.  Also, patients with pain due to nerve irritation affecting a leg or arm often experience greater relief of their symptoms than individuals with only back pain.

What to Expect?

An epidural steroid injection procedure usually takes between 15 and 20 minutes.  The patient lies flat on an x-ray table on their abdomen.  Prior to the epidural injection the skin is numbed with a local anesthetic, similar to the "numbing" medicine a dentist uses.

Using fluoroscopy (live x-ray) for guidance, the physician directs the needle toward the epidural space.  Fluoroscopy is used to identify the correct location in the spine for needle placement.

In some circumstances, the physician may not use x-ray guidance.  The description of the procedure will be as described above with the exception of your position, as you will be placed in a sitting or side-lying position.

Once the needle is in the proper location, the steroid is injected.  Following the injection the patient is usually monitored for 15-20 minutes.  Sedation is available for patient anxiety and comfort.  The patient is usually ready for discharge 45-60 minutes after injection.

What Happens After the Procedure?

After the procedure you may feel numbness or mild weakness of the arms (cervical injections) or legs (lumbar injection).  This is due to the local anesthetic (numbing medicine) and may last 2-3 hours.  You should not drive yourself home.

Patients are usually asked to rest on the day of the epidural steroid injection.

Unless the procedure was complicated, the patient should be able to return to work the next day and can perform the activities that are easily tolerated.  The immediate pain relief is from the local anesthetic in the injection, which usually wears off in a few hours.  The pain relief from the steroid occurs gradually after 48 hours and may take 10-14 days for maximum effect.

It is common to have soreness in the area of the injection.  We recommend the use of intermittent ice packs to the area and over-the-counter analgesics, for example, Tylenol, if this discomfort is bothersome.

What About Risks and Side Effects?

In general, there are few side effects from the steroid injection because the dose is small and carefully controlled.  Diabetics should be aware that blood sugar levels may rise temporarily following the injection (usually 5-7 days).  We recommend diabetics check their blood sugars more frequently during this time and notify their primary care physicians if not able to keep their blood sugar under control.  Rare, but potential complications of an epidural injection include infection, bleeding, nerve injury and allergic reactions.  If the covering of the spinal cord is punctured, a severe headache may result.  If untreated, the headache may last for days or weeks.  The pain physician will discuss these matters with you prior to the procedure, as well as any other questions or concerns.

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