Epidural Injections

How Does an Epidural Steroid Injection Work?

The injection contains a combination of:

• Corticosteroid (a type of anti-inflammatory medication) to reduce inflammation and swelling around the nerves, which helps to relieve pain.
• Local anesthetic (such as lidocaine) to provide immediate pain relief by numbing the area.

By targeting inflammation near the affected nerve roots, the injection aims to reduce pain, swelling, and irritation, which can result from conditions such as herniated discs, spinal stenosis, sciatica, or degenerative disc disease.

Indications for Epidural Steroid Injections

ESIs are typically used for conditions that cause nerve pain, especially when more conservative treatments (like oral medications, physical therapy, or lifestyle changes) have not provided adequate relief. Some common conditions treated with ESIs include:

• Herniated discs: Where the disc material presses on a nerve root.
• Spinal stenosis: Narrowing of the spaces within the spine that can put pressure on the nerves.
• Sciatica: Pain that radiates along the sciatic nerve, often due to a herniated disc or degenerative disc disease.
• Radiculopathy: Nerve root pain caused by compression or irritation of spinal nerves.
• Facet joint arthritis: Inflammation in the small joints of the spine.

The Procedure

1. Preparation: You may be asked to change into a hospital gown, and the area of your back or neck where the injection will be given is cleaned with an antiseptic.

2. Positioning: You may be asked to lie on your stomach or side, depending on the area being treated.

3. Local Anesthesia: The doctor will first inject a local anesthetic to numb the skin and tissue around the injection site. This helps minimize discomfort during the procedure.

4. Needle Insertion: Using fluoroscopy (a type of real-time X-ray) or sometimes CT guidance, the doctor will carefully insert a needle into the epidural space. The needle is positioned near the nerve roots that are causing the pain.

5. Injection: Once the needle is in place, the corticosteroid and local anesthetic are injected into the epidural space.

6. Post-Procedure Monitoring: After the injection, you may be monitored for a short time to ensure there are no immediate side effects. Some people experience temporary soreness at the injection site.

Benefits of Epidural Steroid Injections

• Pain Relief: By reducing inflammation, the corticosteroid can provide significant pain relief that lasts from several weeks to several months, depending on the individual.
• Improved Function: As the pain subsides, many patients find they are able to perform daily activities and physical therapy with greater ease.
• Non-Surgical Option: ESIs provide an option for patients who want to avoid surgery or who are not surgical candidates due to other health concerns.
• Reduced Medication Use: The injection can help reduce reliance on oral pain medications, including opioids.

Risks and Side Effects

Although epidural steroid injections are generally safe, there are some potential risks and side effects, including:

• Temporary increase in pain: Some people experience an increase in pain in the first 24 hours after the injection (known as a “steroid flare”).
• Infection: There’s a small risk of infection at the injection site.
• Bleeding: If you have a bleeding disorder or are on blood-thinning medications, the procedure could cause bleeding.
• Nerve damage: Although rare, the needle could potentially cause nerve damage.
• Steroid side effects: While corticosteroids are effective at reducing inflammation, they can cause temporary side effects such as mood changes, fluid retention, or elevated blood sugar in some individuals.
• Headache: A headache can occur, especially if the needle punctures the protective layer around the spinal cord (dural puncture), but this is uncommon.
• Fatigue or difficulty sleeping: Some people may feel more tired or experience sleep disturbances after the injection.

Effectiveness

The effectiveness of an epidural steroid injection varies depending on the individual and the underlying condition. While many people experience significant pain relief, others may not respond as well. In some cases, multiple injections may be needed to achieve optimal results. ESIs are generally used as part of a comprehensive treatment plan, which may also include physical therapy, medications, and lifestyle changes.

Follow-Up and Considerations

• Follow-Up: After the injection, it’s important to follow up with your healthcare provider to evaluate the effectiveness of the treatment and to determine next steps. Some individuals may benefit from additional injections, while others may progress to surgery if pain persists.
• Limitations on Frequency: Epidural steroid injections are typically limited to a few per year (usually 3-4) due to the risks of side effects from prolonged corticosteroid use. The exact frequency depends on your healthcare provider’s recommendations.