Epidural Steroid Injections - Here's What You Need to Know

Steroids (cortisone) have a potent anti-inflammatory effect when injected into the epidural space, decreasing pain and improving function for patients. Epidural Steroid Injection (ESI) is a minimally invasive procedure and helps to relieve neck, arm, leg, and back pain. The goal of this procedure is to reduce pain, and relief can last from several days to even years.

Think of the epidural space as a fat-filled sleeve that protects the spinal sac by surrounding it and providing cushioning for the spinal cord and nerves. Spinal passages may narrow for a variety of reasons, such as bone spurs, disc herniations, thickening of the ligaments in the spine, joint cysts, and abnormal vertebrae alignment.

What Are the Benefits of Epidural Steroid Injections?

The benefits of an ESI include pain relief and improved quality of life, including as a treatment after a surgery. The steroid will usually begin to work within 1-3 days after injection, however some people may not feel the benefits for a number of weeks. ESIs are usually a safe and effective treatment for arm, neck, back, and leg pain and have been performed for decades.

What Conditions Are Treated by This Procedure?

Patients who suffer from consistent pain in their arm, neck, leg, or back are all candidates for this kind of treatment. Specifically, the kinds of conditions treated by this procedure include:

• Herniated disc – The gel-like material within discs are susceptible to bulge or rupture through a weak area in the surrounding wall, causing swelling, irritation, or pain when the material squeezes out and comes in contact with a spinal nerve.
• Degenerative disc – Related to age, degenerative discs happen when one or more discs between the vertebrae deteriorates or breaks down, which causes pain.
• Spinal stenosis – The narrowing of spaces within your spine, including spinal canal and nerve root canal, can put pressure on the nerves and cause leg and back pain.
• Spondylolisthesis – A slipping of the vertebrae that occurs at the base of the spine in most cases due to a weakness or fracture between the upper and lower facets of a vertebrae. Slipping forward can compress the nerve roots, causing pain.
• Sciatica – This is back pain caused by a problem with the sciatic nerve, usually as a result of compression of the fifth lumbar or first sacral spinal nerve.

Can Epidural Steroid Injections Reduce Back Pain?

The short answer is yes! ESIs are used to primarily reduce pain, including back pain. ESIs are performed to reduce the inflammation and resulting pain associated with compression of the nerve root. Nerve root compression can happen as a result of bone spurs, herniated discs, or any of the other conditions listed above. Compressed nerves become inflamed leading to pain, numbness, tingling, or weakness along the nerve.

People suffering from back pain should talk to their doctor about thoracic and lumbar epidural injections specifically, which are injected in the middle back and low back respectively.

How Are Epidural Steroid Injections Administered?

Before the procedure can even begin, there are steps you will take to prepare. The doctor performing your injection will review your medical history and study previous images to plan for the best approach. They may ask you questions at this time.

Patients on blood thinning medication (like Plavix, Xarelto, etc) may need to stop taking it several days before the procedure. Any medications should be discussed with your doctor prior to the procedure taking place. It is best if you talk to both your prescribing physician and to the doctor who will perform the injection.

X-Ray Fluoroscopy

The procedure is usually performed using x-ray fluoroscopy in an outpatient center. The x-ray fluoroscopy greatly improves the precision of the injection and the outcome of the procedure. You should make arrangements to have someone else drive you to and from the center on the day of the injection.

After consent forms are signed, the procedure will begin and typically lasts between 15-45 minutes, followed by a period of recovery. The goal is to inject the cortisone as close to the inflamed nerve as possible. The type of injection will depend on the presence of metal rods or screws as well as the condition the patient is suffering from.

Applying a Local Anesthetic

First, the doctor will prepare you by having you lie down on an x-ray table. To numb the area of the treatment, local anesthetic will be used so that any discomfort will be minimized throughout the procedure. Patients remain awake during the injection to provide feedback. Certain outpatient centers may offer a low dose oral sedative, such as Valium.

At this point, the doctor will direct a hollow needle through the skin and between the vertebrae into the epidural space with the aid of an x-ray fluoroscope. Fluoroscopy allows the doctor to track the needle on a monitor in real time. This ensures that the needle will go to the right location. Contrast dye is also used to confirm the area where the medication will flow. Most patients feel pressure at this point other than pain.

Your doctor will decide with type of ESI is right for you. The different types include:

• Cervical (neck) – Inserted in the side of the neck, the medication deposited from the needle may reach the neural foramen, which is just above the opening for the nerve root and outside the epidural space.
• Interlaminar (wide area) – Often referred to as an ‘epidural injection,’ interlaminar ESIs involve placing the needle into the back of the epidural space and delivering the cortisone over a wider area.
• Lumbar (low back) – The needle is inserted slightly off the midline of the back to reach the nerve canal.
• Caudal (tailbone) – In this type, the needle is placed in the sacral hiatus above the tailbone, where it can reach the lowest spinal nerves.

Are You a Candidate for Epidural Steroid Injection?

Patients suffering from some of the painful inflammatory conditions listed above have experienced relief after getting an ESI. Epidurals can ease the pain that interferes with a person’s rehabilitative exercises, allowing them to continue with their physical therapy. Additionally, getting an ESI can help some patients determine whether surgery might be beneficial for herniated disc pain.

People with an infection or bleeding problems are NOT candidates for an ESI. Patients with diabetes could experience a slight elevation in blood sugar levels after the injection. Patients with glaucoma may also experience temporary elevations of blood pressure and eye pressure after an injection. Discuss this with you physician.

Anyone who may be pregnant should tell their doctor as fluoroscopy x-rays can be harmful to a baby.

Schedule a Consultation To Learn More

People who have experienced ongoing pain related to nerve compression and spinal narrowing should know all of the options available to them for relief. If you have suffered from any of the qualifying conditions or are experiencing ongoing neck, arm, back, or leg pain, speak to one of our qualified surgeons about the possibility of getting an epidural steroid injection.

We are located in seven convenient locations around Central Florida—schedule a consultation today!