Epidural steroid injection is a term applied 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 bony spinal column.
This is the space into which disc material can potentially herniate (jut out unnaturally) and cause pressure and inflammation around spinal nerves.
They are commonly used to treat back pain caused by a herniated disc (slipped disc) or spinal stenosis, and lower back pain and leg pain caused by sciatica. Corticosteroids are strong anti-inflammatory medications, 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 nonsurgical 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.
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.
Although all precautions are taken and incidence is low, infections can be introduced by any needle. Other serious complications are rare, and usually only temporary, but it is important to talk with your doctor about your medical history. People with certain conditions should not receive epidural steroid injections.
Some contraindications for performing epidural steroid injections include:
In addition, in patients who have diabetes or congestive heart failure, additional precautions must be taken by the doctor performing the procedure. The current use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) is not an absolute contraindication, but some doctors instruct their patients stop using these medications for up to seven days before the planned injection in order to reverse antiplatelet effects in the bloodstream.
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.
Common temporary side effects can include bleeding, headaches and feeling flush. People who have diabetes may experience a temporary increase in their blood sugar. This should be discussed with your doctor prior to the procedure. Patients may also experience a temporary numbness and tingling.
Your doctor will give you specific instructions, but you typically arrive about one hour before the procedure. Some patients require blood work to rule out an infection or bleeding risks. You can usually can eat a light meal four hours prior to the procedure and resume normal eating habits after.
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 to 30 minutes and requires the patient to lie prone or on their side. After the procedure, patients are asked to rest in a supine (flat on their back) or sitting position for a brief time.