EPIDURAL STEROID INJECTIONS
Epidural steroid injections are injections of anti-inflammatory medications (corticosteroids) into the spinal canal. These injections are intended to relieve the pain from conditions such as disc herniations, spinal stenosis, or spondylolisthesis.
What is it?
Epidural steroid injections are a common treatment for many forms of low back pain and leg pain. They play an integral part the management of the non-operative arm/leg and neck/back pain.
What is its goal?
The goal of the injection is pain relief. Often the injection alone is may not provide complete relief but is commonly used in combination with a comprehensive rehabilitation program and other medications.
How is it done?
Patients may be asked to change into a hospital gown, allowing for access to the injection site. The procedure usually takes around 15-20 minutes:. The patient lies flat or on their side on an x-ray table. The skin at the injection site is cleaned and then numbed with a local anesthetic similar to what a dentist uses. Fluoroscopy (live x-ray) is then used for guidance, as a needle is inserted and directed toward the epidural space. Contrast is injected to confirm the correct location. Following this the epidural steroid solution is injected. Most patients sense some pressure during this part though this is not generally painful. Following the injection, the patient is monitored for 15 to 20 minutes before being discharged home. Sedation is available for patient anxiety and comfort, yet rarely necessary, as the procedure is typically not uncomfortable. If a sedative is used, you will not be allowed to eat or drink for several hours prior to the procedure and having someone available for discharge. There is no definitive number of epidural steroid injections that should be administered or how frequently they should be given. In general, we perform up to three epidural injections per year, which is about the frequency that many arthritis patients receive cortisone shots for shoulder and knee pain.
What are the risks?
There are several risks associated with epidural injections, although they are all relatively rare. In addition to temporary numbness of the bowels and bladder, the most common potential risks and complications include:
Infection (severe infections are rare, occurring in 0.1% to 0.01% of injections)
Dural puncture (occurs in 0.5% of injections)
Bleeding (rare and is more common for patients with underlying bleeding disorders)
Nerve damage (extremely rare, but can occur from trauma by the needle)
In addition to risks from the injection, there are also potential side effects from the steroid medication itself. These tend to be rare and much less prevalent than the side effects from oral steroids. Nonetheless, reported side effects include:
Localized increase in pain
Non-positional headaches resolving within 24 hours
Fever the night of injection
High blood sugar
A transient decrease in immunity because of the suppressive effect of the steroid
Severe arthritis of the hips (avascular necrosis)
What is the success rate?
Although effects of epidural steroid injection tend to be temporary (lasting 1 week to up to a year) an injection can provide substantial pain relief and benefit. With fluoroscopic guidance > 50% of patients receive some pain relief. Pain relief is often better for radicular (leg or arm) pain than back or neck pain. Pain relief and control from injections can improve a patient’s quality of life, minimize the need for painkiller use, and potentially delay or avoid surgery. Success rates can vary depending on the condition that patient has. If a patient does not receive any relief from the first epidural injection, further injections may not be beneficial.
How long will I stay at the pain center ?
This is an outpatient procedure and the patient is typically only observed for 15-20 minutes after the injection before being sent home. Tenderness at the needle insertion site can occur for a few hours after the procedure and can be managed by periodically applying an ice pack. In addition, patients are usually asked to rest for the remainder of the day and normal activities may typically be resumed the following day. A temporary increase in the pain can occur for several days after the injection due to the pressure from the fluid or chemical irritation from the injection.