Epidural corticosteroid injections place medication directly around a pinched nerve as it exits the spine within the epidural space. The epidural space is between the bones and discs of the spine, and the nerves and spinal cord. This is the space into which disc tissue can herniate and cause pressure and inflammation around spinal nerves.
Epidural steroid injections are commonly used to treat back pain caused by a herniated disc (slipped disc), lumbar radiculopathy, spinal stenosis or sciatica. Corticosteroids are strong anti-inflammatory medications and, when placed into the epidural space, can significantly reduce inflammation around an irritated nerve that is causing back and leg pain and discomfort.
Patients with several common conditions – including lumbar disc herniation, degenerative disc disease, lumbar radiculopathy, sciatica, lumbar spinal stenosis, postherpetic neuralgia and facet/synovial cysts – may benefit from an epidural injection. An epidural steroid injection may be an effective nonsurgical treatment in itself or may aid in surgical planning.
Epidural steroid injections work by delivering a potent anti-inflammatory to the site of nerve impingement in the spine. Injected medications may include steroids, local anesthetics, and saline, and they can vary in volume and concentration on an individual basis.
Three routes may be used for epidural injections in the lumbosacral spine:
Your physician will choose which method is right for you based on your diagnosis and if you have had any prior spine surgeries.
Epidural steroid injections are recommended to be administered up to three to six times per year. In the case of a new disc herniation, injections may be only weeks apart with a goal of quick and complete resolution of symptoms. For chronic conditions, three to six months or more between injections is common.
Epidural steroid injections can help resolve pain permanently in patients with a new disc herniation who respond favorably. For patients with chronic pain or recurrent disc herniations, the desired duration of effect is three to six months or more.
The risks in any procedure involving a needle include bleeding, infection and nerve damage. When performed properly, the risk of any of these is exceedingly low and usually outweighed by the potential benefit of the procedure.
Some contraindications for performing epidural steroid injections include:
Common side effects include mild injection site pain, temporary worsening of usual pain, flushing, insomnia, or increased blood sugar. These are usually self-limited and resolve within one to three days. A less common side effect is headache.
Your doctor will give you specific instructions and these will vary by facility and type of epidural (lumbar, thoracic or cervical). Because the procedure is usually performed with local anesthetic, fasting guidelines are not overly prohibitive.
A local anesthetic is injected into the skin, numbing the area where the epidural needle is then placed. Patients may experience mild discomfort but should not experience severe pain during the procedure.
The procedure can last anywhere from 10 to 20 minutes and requires the patient to lie prone, if possible, to allow for X-ray guidance (fluoroscopy). After the procedure, you can sit, stand, and walk as usual after a short period of monitoring.
Epidural steroid injections at HSS are performed by several types of doctors – pain management physicians, physiatrists and interventional radiologists – all of whom are trained to safely perform this procedure, often with additional subspecialty fellowship training.