Epidural Steroid Injections

What is an Epidural Steroid Injection?

An epidural steroid injection is a procedure that helps to relieve back, neck, arm and/or leg pain that is caused by a bulging disc or irritated nerve root in the spine. It is an injection of steroids and local anesthetic into the epidural space of the spine to provide pain relief.

How does it work?

Corticosteroid is a strong anti-inflammatory medicine that can reduce the inflammation that occurs from a bulging or herniated disc. The corticosteroid is injected, along with a local anesthetic medicine (like novacaine) to provide pain relief. The medicine is placed into the epidural space, which is the space between the disc, spinal cord and spinal nerve.

How is it done?

A needle is directed into the epidural space under X-ray guidance. Moderate sedation and/or a local anesthetic may be used to ensure our patient's comfort. A small amount of X-ray dye is injected to confirm epidural placement of the needle. Then a mixture of steroids and local anesthetic is injected. This feels like a pressure or “fullness” along the path of the irritated nerve root. The needle is then removed and the patient is taken to the recovery room.

What are the risks of the procedure?

As with any invasive procedure there are some associated risks and complications. Any time a needle is put into the body, there is a risk of infection or bleeding, or allergic reaction. The risk of infection is reduced by using sterile techniques. The risk of bleeding is very minimal if you are not on any blood thinners. There are very few allergic reactions to the medications that are used for the injection. If any allergic reactions are identified, medications will be given and you will be observed to prevent any serious complications. Steroids may have several side effects but are limited due to the small amount of medication used in the procedure.

Epidural steroid injections also pose a risk for a spinal headache, weakness, and increased pain. A spinal headache is a headache that gets worse when you sit up. It usually improves in 1-2 days with lying down flat, drinking water and taking caffeine. Occasionally, a persistent spinal headache must be treated with a blood patch. Please contact the office if you have a persistent spinal headache. If you develop weakness after an epidural steroid injection, it usually improves in 4-5 hours as the local anesthetic wears off. If you develop increased pain after the injection, it should improve in 2-3 days as the effect from the steroid starts working, and the injected fluid dissipates.

What do I do before the injection?

Patients must not eat or drink for 6 hours prior to the injection. All anti-inflammatory medications (ibuprofen, naproxen, NSAIDS) must be stopped for 3 days prior to the injection. If you are on any blood thinners (aspirin, coumadin, warfarin, heparin, plavix, aggrenox, lovenox, etc.) the physician or nurse must be notified prior to the injection. Please alert the physician or nurse if you have any allergies to X-ray dye. Please bring any films, X-rays, MRI scans or CT-scans with you on the day of the injection. All patients must have someone to drive them home.

What can I expect afterwards?

Most patients get immediate relief of some of their pain. Most patients go home about 20-30 minutes after their injection. Patients are advised to rest on the day of the injection, but may return to their normal activities the next day. The pain usually returns in about 4-5 hours, as the local anesthetic will wear off. The soreness and pain should improve in about 2-3 days as the steroids start to decrease the inflammation. Patients will often be instructed to make a follow-up appointment after the injection.