Epidural Steroid Injections: Frequently Asked Questions

What are epidural steroid injections?

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.

What are epidural corticosteroid injections used for?

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.

Who can benefit from an epidural steroid injection?

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.

How do epidural corticosteroid injections work?

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.

  • 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.
  • 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.
  • 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.

What are the risks of epidural steroid injections?

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:

  • bleeding disorders or anticoagulation
  • medication allergies
  • pregnancy or inability to be positioned horizontally or lie prone (flat on the stomach)

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.

What are the side effects of epidural steroid injections?

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.

Is any preparation required? Can I eat before and after my epidural steroid injection?

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.

Is any anesthesia used? Are epidural steroid injections painful?

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.

Will I have to lie flat on my stomach for long during or after the procedure?

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.

Who performs epidural steroid injections?

Epidural steroid injections at HSS are performed by physiatrists, pain management doctors, and radiologists, all of whom are physicians with the required expertise to safely perform this procedure.

Authors

Pain Management Division
Hospital for Special Surgery

 

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