Epidural steroid injection is a term applying to a variety of techniques performed to deliver corticosteroid medication around a nerve coming out from the spinal cord in an epidural space. This epidural space is the space between the dural sac - which surrounds the spinal cord and exiting spinal nerves - and the boney spinal column. This is the space into which disc material can potentially herniate (jut out unnaturally) and cause pressure and inflammation around spinal nerves. Corticosteroids are medications that have strong anti-inflammatory properties, and spinal injections of corticosteroids significantly reduce inflammation around an irritated nerve that is causing pain and discomfort.
Patients with several common conditions - including a lumbar disc herniation, degenerative disc disease, and lumbar spinal stenosis - may benefit from an epidural injection. For these and other conditions that can cause acute or chronic pain, an epidural steroid injection may be an effective non-surgical treatment option.
Three routes may be used for epidural injections in the lumbosacral spine: caudal, translaminar, and transforaminal. Your physician will choose which method is right for you.
- The caudal injection is the least complicated way to access the epidural space; however, it is not as localized or confined an injection as the transforminal approach.
- The translaminar injection delivers the medication directly into the epidural space and therefore closer to the source of pain. However, the medication is not guaranteed to flow to the front epidural space, the area where the irritated nerve can be found. Translaminar injections are still utilized by some physicians if a transforaminal injection cannot be performed and are otherwise at the discretion of the treating physician.
- The transforaminal technique requires a fluoroscope, which is a special x-ray machine that allows your doctor to see “dynamic” images that allow for precise needle placement. This technique is favored because of the precision with which solutions can be delivered to a specific nerve root and the front location of the needle in the epidural space.
Several different steroid preparations may be used, with or without local anesthetic, to increase the volume and ensure the spread of medication to all areas causing pain.
There are a few contraindications to performing lumbosacral epidural steroid injections, including bleeding disorder, anticoagulation, and allergy to medications. Other contraindications include pregnancy and the inability to be positioned horizontally or to “lie prone”. Diabetes and congestive heart failure require caution by the doctor performing the procedure. The current use of aspirin or nonsteroidal anti-inflammatory drugs is not an absolute contraindication, but some physicians opt to have their patients stop using these medications up to 7 days before the planned injection in order to reverse the antiplatelet effect, depending on the physician’s preference.
Although all precautions are taken and incidence is low, infections may be introduced by any needle stick. More common temporary side effects include bleeding, headaches, and flushing. Patients with diabetes may have a temporary increase in their blood sugar. This should be discussed with your physician prior to the procedure. Patients may also experience a temporary numbness and tingling.
If you are a potential candidate for an epidural steroid injection, it is important to note that the risks of an injection are usually outweighed by the pain relief and positive outcome of the procedure.
It is important to talk with your doctor about your personal medical history even though complications are uncommon and usually temporary, and serious complications are rare.
Your physician will give specific instructions prior to the procedure. Generally, patients come in about one hour prior to the procedure. Some patients require blood work to rule out an infection or bleeding risks. Patients usually can eat a light meal 4 hours prior to the procedure, and they can resume their normal eating habits after the procedure.
Typically a local anesthetic is injected into the skin, numbing the area where the epidural needle is placed. Patients may experience a mild discomfort but not severe pain.
The procedure can last anywhere from 15-30 minutes and requires the patient to lie prone or on the side. After the procedure, patients are asked to rest in a supine [flat on his/her back] or sitting position for a brief time.
Epidural steroid injection at Hospital for Special Surgery is performed by physiatrists, pain management physicians, and radiologists, all of whom have the expertise necessary to safely perform this procedure.