Epidural Steroid Injection

What is an epidural steroid injection?

An epidural steroid injection is a common procedure to treat spinal nerve irritation that is caused by tissues next to the nerve pressing against it. The beginning of the nerve (nerve root) is most often irritated by an inflamed intervertebral disc, or disc contents, directly touching the spinal nerve.

•ESIs are used as a block to treat pain. This procedure is beneficial because it can deliver anti-inflammatory medication directly to the source of the pain.
•ESIs can often be delivered in a series of three injections to provide the maximum pain relief. Your physician can discuss with you why a series of injections would be beneficial in your case or not.

How is an epidural steroid injection performed?

The epidural steroid injection procedure is quick and simple. While it is common for people to be concerned prior to the procedure, it is actually frequent to hear from patients afterwards: “Is that all?”

The spinal cord rests in the spinal canal. The nerve roots branch out from the spinal cord at each level of a spinal vertebra (the bony building blocks of the spine). The cord is protected by cerebrospinal fluid (CSF), which serves as a shock absorber for the cord. The CSF is held in place by a membrane with several layers, one of which is called the dura, from the Greek for tough (think of “durable”). The Greek word “epi” means “outside of.” So, the epidural space is outside of this tough membrane. During an epidural steroid injection, a needle and syringe are used to enter the epidural space and deposit small amounts of long-lasting steroids around the inflamed spinal nerve. A fluoroscope (a viewing instrument using X-rays) is used to visualize the local anatomy during the injection. The epidural steroid injection specifically targets the inflamed area and treats it with a maximal amount of steroids, thereby minimizing exposure of the rest of the body to the steroids.

When are epidural steroid injections used?

Epidural steroid injections are most commonly used in situations of radicular pain, which is a radiating pain that is transmitted away from the spine by an irritated spinal nerve. Irritation of a spinal nerve in the low back (lumbar radiculopathy) causes pain that goes down the leg. Epidural injections are also used to treat nerve compression in the neck (cervical spine), referred to as cervical radiculopathy.

What are the risks associated with ESIs?

  • Some risks include nerve damage, infection, bleeding, bowel/bladder problems, and sexual dysfunction.
  • Patients who have diabetes can have an increase in blood sugar due to the steroid and should pay close attention to their blood sugars.
  • Your doctor will discuss the possible side effects with you before your procedure and you can ask any questions at that time.

What should I expect during the procedure?

  • The procedure is performed in the surgery center. This procedure takes approximately 30-45 minutes and does not require you to be sedated in most cases. A local anesthetic will be applied to the injection site to prevent pain associated with the injection. Some patients feel pressure in the back or down their legs.
  • Flouroscopy is used to determine proper placement of the needle before the injection takes place.
  • Contrast dye is also used to make sure the needle is properly placed near the irritated nerve or nerves.
  • A combination of an anesthetic and corticosteroid solution is injected into the epidural space. The steroid is an anti-inflammatory medication that is absorbed by the inflamed nerves to decrease swelling and relieve pressure.

What should I expect after the procedure?

  • After the needle is removed and a small bandage is applied, you will go to the patient recovery area. You will be offered a snack and something to drink. Before you leave, you will be given post treatment instructions and you will be given a chance to ask any questions that you have at that time.
  • Some patients may need only one injection to feel relief, but in some cases two or three injections may be needed to provide significant relief.