Epidural Steroid Injections
Epidural Steroid Injections Overview
An epidural steroid injection (ESI) is a minimally invasive procedure that can help 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 degeneration or herniation. The effects of ESI tend to be temporary. Pain relief may last for several days or even years. The goal is to reduce pain so that you may resume normal activities and a physical therapy program.
What is an epidural steroid injection (ESI)?
An epidural steroid injection includes both a corticosteroid (e.g., triamcinolone, betamethasone) and occasionally an anesthetic numbing agent (e.g., lidocaine, bupivacaine). The drugs are delivered into the epidural space of the spine, which is the area between the protective covering (dura) of the spinal cord and the bony vertebrae.
Corticosteroid injections can reduce inflammation and can be effective when delivered directly into the painful area. Unfortunately, the injection does not make a herniated disc smaller; it only works on the spinal nerves
There are three ways an ESI can be performed; transforaminal, interlaminar or caudal. The right type of injection depends on your condition and which procedure will likely produce the best results and the least discomfort of side effects. Fluoroscopy (X-ray) is ALWAYS used to ensure both safety and accuracy.
Prior to the procedure
Patients who take blood thinner medication (Coumadin, Heparin, Plavix, Ticlid, Fragmin, Orgaran, Lovenox, high-dose aspirin) may need to stop taking their medications prior to the ESI. You must obtain approval from your prescribing physician prior to stopping any medication.
If you think you may be pregnant or are trying to get pregnant, please tell the doctor. Fluoroscopy X-rays are used during the procedure may be harmful to the fetus.
Sedation is rarely necessary or used, but If it is used you must take nothing by mouth for 4 hours prior to the procedure.
Day of the procedure:
- Plan to arrive 30 minutes before your scheduled appointment time.
- We recommend that you have something light to eat before the appointment.
- Make arrangements to have someone drive you to and from the office the day of the procedure.
- The procedure generally takes 15-30 minutes followed by a recovery period.
Step 1: Prepare the patient
The patient lays face down on the table, the skin is cleaned and the skin is numbed with a local anesthetic.
Step 2: Insert the needle
With the aid of a fluoroscope (a special X-ray), the doctor directs a needle through the skin to the area of the facet joints. Fluoroscopy allows the doctor to inject contrast and ensure correct placement of the needle.
Step 3: Inject the medication
When the needle is in place, the medications are delivered on to each facet joint. The needle is then removed.
Step 4: Recovery
Most patients can walk around immediately after the procedure. After being monitored for a short time, you usually can leave the office or suite. Someone must drive you home.
After the procedure
Typically patients resume full activity the next day although we do recommend ‘taking it easy’ for 2-3 days after the procedure. Soreness around the injection site may be relieved by using ice and taking a mild analgesic (Tylenol). The patient may resume taking all medications immediately after the procedure.
Generally, facet injections begin to work within 3 or 4 days although it may take as long as 7 days for the steroid to start working.
What are the results?
Most patients experience some pain relief from facet injection, on average lasting form 3-4 months. More importantly, the timing of injections should coincide with the start of physical therapy and/or home exercise program to strengthen the back muscles and prevent future pain episodes.
What are the risks?
As with any procedure, there are both potential risks and benefits. ESI is generally safe and serious complications are rare especially when using proper safety techniques such as fluoroscopy. The potential risks associated with inserting the needle include spinal headache from a dural puncture, bleeding, infection, allergic reaction, elevated blood pressure, nerve damage/paralysis (rare) and death. Corticosteroid side effects may cause weight gain, water retention, flushing (hot flashes), mood swings, insomnia, and elevated blood sugar levels in people with diabetes. Any numbness or mild muscle weakness usually resolves within 3-8 hours in the affected arm or leg (similar to the facial numbness experienced after dental work).
ESI should NOT be performed on people who have an infection, are pregnant, or have bleeding problems.