Epidural Steroid Injections
What is an Epidural Steroid Injection?
An epidural steroid injection is the injection of medications including corticosteroids into the epidural space. The epidural space is a small space that surrounds the covering of the nerve roots and the spinal cord. It is done using fluoroscopy which is a specialized x-ray technology that allows us to see things move in real time. This allows us to identify the epidural space so that we can safely and precisely guide a specialized needle into it. There are several different approaches that can be used. They are referred to as a trans-foraminal approach (from the side of the spine), interlaminar (from the top of the spine), and caudal (from just above the tail-bone). The approach used is based on your symptoms and imaging findings. Once the needle tip is accurately positioned in this space, a contrast dye is injected to confirm proper placement of the needle tip. Once the dye confirms proper needle placement, we proceed to inject local anesthetic and a powerful anti-inflammatory dose of corticosteroids. This type of injection can dramatically decrease swelling, irritation and inflammation of the nerve roots resulting in profound pain relief for a period of time.
What conditions can be helped with an Epidural Steroid Injection?
Typically, any condition that results in irritation and inflammation around the nerve roots can be treated by an epidural steroid injection. Some of these conditions include: pinched nerves, disc bulges and herniations, spinal stenosis, and spinal disc tears.
What are some side effects from Corticosteroids?
Usually an injection or two rarely has any lasting significant effects on the body. It may take up to 6 weeks for the cortisone to be removed from the body. With repeated doses of cortisone, there is the potential of weakening supporting structures such as tendons, muscles and ligaments. There can also be a temporary increase in blood sugars for diabetics, swelling, or a change in a woman’s menstrual cycle. Most of the studies demonstrating the more serious side effects of cortisone (e.g. osteoporosis, cataracts, and increased blood pressure) are based on patients who have taken cortisone pills on a daily base for months to years. This is the reason why we limit the total number of epidural steroid injections for most people to about 3 per 6 months; and 3 per every 12 months for those with more significant medical problems, such as cardiac conditions, osteoporosis, and diabetes. Typically, injections have less systemic side effects as opposed to taking oral cortisone pills, thus the benefit of a cortisone injection over pills.
What are the potential complications of an Epidural Steroid Injection?
Epidural steroid injections are quite safe to perform if they are performed by a well-trained physician. The main potential complications include, but are not limited to: bleeding, infection, and nerve injury or spinal cord injury. The risk of nerve damage can range from 1 in 10,000, to 1 per 100,000 based on studies. The risk of death from an epidural steroid injection is extremely rare and can range from 1 in 500,000 to 1 in 1,000,000. Some patients may have a temporary increase in pain for a day or two, before the corticosteroids begin to kick in and it can take about 7 days to achieve maximal effect.
How long does the procedure take?
For most epidural steroid injection procedures performed in the office setting, the actual procedure itself takes about 30 minutes. The time depends on how many levels of the spine are injected as well as the complexity of your spine. For example, patients with a history of severe arthritis and surgery require a longer period of time to maximize safety.
How long is the recovery period after an Epidural Steroid Injection?
It is recommended to rest the day or night after the procedure and to maintain minimal activity the following day. This includes no fast walking, exercise, running or workouts. The corticosteroids can be more quickly metabolized by the body if you are more active.
Do Epidural Injections hurt?
The vast majority of people can tolerate an epidural steroid injection with the use of local anesthetics which are injected under the skin to numb the injection site. On rare occasions when the nerve roots are very inflamed, there may be a sensitivity as the needle is placed near the injection site as well.