Epidural Steroid Injections
By Dr. Jarka /Dr. Rhett Atkinson
What causes your pain?
Occasionally, conditions such as herniated discs, spinal stenosis, arthritis, bone spurs or injury may cause pressure on the nerve roots which leave the spinal canal in the neck or low back region, leaving them inflamed and irritated. Often the inflammation of these nerve roots and the subsequent pain arising from the inflammation can be lessened and sometimes even eliminated by the injection of strong anti-inflammatory drugs called steroids into the epidural space of the spinal canal. This space is located just outside of the sac which contains your spinal cord. The spinal nerve roots pass through this epidural space and they can therefore absorb medications placed into this space.
How is the procedure done?
With you usually in a prone position (lying face down on the bed), I use local anesthetic to numb the skin over your spine at or near the level of your inflamed nerve(s). I then place a needle through this anesthetized area and using an x-ray machine (fluoroscope) to verify that the needle is in just the right location, the needle is placed into your epidural space next to the nerve(s). It is here that the steroid is injected, along with a small amount of saline solution. The desired result is a decrease in the inflammation of the affected nerves with, hopefully, substantial relief of your pain over the following 7 to 14 days. The procedure usually takes less than 30 minutes. Though I will give you sedation during the procedure if necessary, in most cases you will experience very little discomfort (usually about the same as having an IV started) as the needle is inserted. Some patients, however, may experience a pressure sensation as the needle is placed into the correct position and often patients experience pain similar to their regular nerve root pain as the steroid solution is injected into the epidural space. In addition, some patients may notice an increase in discomfort after the injection. If this occurs, it usually resolves within a few days, but you can always call me if you're concerned. Of course, since I am using x-ray to verify the proper needle location, women of childbearing age will be asked to verify that they are not pregnant.
What are the benefits?
The benefit of epidural steroid injection is the potential for the lessening or elimination of your nerve root pain. Over half the patients who have an epidural injection report 50% to 75% pain relief, but both the quantity and quality of the pain relief you will obtain are unpredictable in advance. Some patients experience 100% relief while others get no relief at all. The duration of pain relief is also variable with some patients never having pain again while at the other extreme some patients notice no relief at all. Epidural steroid injection is, however, often a reasonable treatment option for you when conventional treatment such as pain medicines, bed rest, exercises and physical therapy have failed to give relief, and when one would like to avoid surgery, if possible.
Your physician will refer you for epidural steroid injection, and will inform me of your age, presumed diagnosis, and results of any pertinent tests which may have been done, such as MRI or CT scans. Once this information is received my office will call you to schedule the procedure with you. We will go through your history and the details of the procedure, as well as answer any questions that you may have at the surgery center before proceeding. Please be patient if you are not called immediately. Every effort, however, will be made to schedule your injection at the earliest and most convenient time for both of us.
Because some patients can feel faint during the procedure it is preferred that you not eat or drink anything for four hours prior to your injection. Most medications, however, should be taken as prescribed with small sips of water, though you should let me know if you are on blood thinners such as warfarin, coumadin, Ticlid, Eliquis, Plavix or aspirin, because often these medications must be stopped for up to a week before the procedure.
What are the potential problems?
As with any medical procedure, epidural steroid injection does have the potential for side effects or complications. Aside from the problems already mentioned, that you may not obtain any relief or that your symptoms may worsen after the injection, the most common (occurring about 1% of the time) is spinal tap, which may result in your procedure being postponed, plus the possibility of a spinal headache. This headache can range from mild to incapacitating. The primary treatment is bed rest and pain medicines, but if the headache is severe and lasts more than a few days, another procedure can be carried out which usually eliminates the headaches very rapidly. The more serious, but very rare complications include nerve paralysis, infection of the spine, or causing bleeding which could compromise a nerve root. Serious complications such as these are very rare, with an incidence of probably no more than 1 in 6000. I will have a more full discussion of the risks and benefits of the procedure when I talk with you, taking into account your special circumstances.
What should I expect after the injection?
You will be expected to have a ride following the procedure or have someone available to give you a ride if necessary. Most patients will be able to resume normal activities almost immediately after the injection, but as stated above, some patients may have increased nerve root pain following the injection. These patients are advised to rest in a comfortable position for a day or so, and continuation of prescribed pain medicines remains appropriate as needed for post-injection pain.
Follow-up visits to your referring physician after your injection vary. At a minimum, you should call your referring physician 10 to 14 days following your injection to discuss your experience with the block. Since the injection takes a week or two to take maximal effect, I will usually wait until then to follow-up with you by phone.
All of your physicians hope your nerve root pain will resolve without surgery, and an epidural steroid injection is one treatment option that may help you obtain this goal.
Please click on the link below to be redirected to the website spine-health.com to see a video animation of a lumbar (lower back) epidural steroid injection