The term “epidural steroid injection” refers to the injection of corticosteroids into the epidural space of the vertebral column as a means of treating pain caused by irritation of the spinal nerves. These injections are also used to confirm a specific diagnosis.
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How does an epidural steroid injection work?
There are two ways in which epidural steroid injections may work, however, there is little scientific evidence supporting either of these theories. The first belief is that some leg or arm pain involves the inflammation of one or more of the nerves, their covering, or their roots, in the back. The injection of steroids into the part of the spinal column called the epidural space is thought to aid in reducing this inflammation. The other belief is that the corticosteroid acts like a local anesthetic and reduces pain to allow the body to begin the process of repairing itself.
The goal of an epidural steroid injection is to reduce pain, and the effect differs from person to person. Most patients will receive good relief for some weeks or up to three months after an injection, but only a small proportion obtain longer-lasting relief. Some patients do not experience any pain relief and may in fact suffer an increase in pain and/or other symptoms.
Before the Injection:
Please do not eat or drink anything two (2) hours before the procedure, and do not take any pain relievers 6 hours prior to the procedure.
If you are on blood thinners, please contact the office where your procedure is scheduled and notify them that you are taking anticoagulants. To have the injection you will need to check with your primary doctor for approval to be off your medication at least 3-7 days prior to the procedure. Patients on Coumadin require a protime/INR blood test the day before the procedure with an acceptable value of 1.5 or below. Bring these results with you to your appointment.
What to Expect:
The test is done by a physician in the surgery suite, using fluoroscopy (a visual X-ray process). You will be positioned on a table so that your vertebral spaces are as widely separated as possible. A small area will be prepared with an antiseptic solution before an epidural needle is introduced and advanced into the epidural space of the spine.
When the needle is in the epidural space, a syringe containing a local anesthetic and the corticosteroid solution is connected to the needle. The doctor injects the solution slowly. The doctor may ask you to describe what sensations you are feeling while the solution is being injected. Sensations of “pins and needles” in your legs, or headache or a sudden sharp pain should be reported.
The corticosteroid injected may be combined with a local anesthetic or with plain saline solution. The dosage and components of the solution injected vary per individual.
You are unlikely to benefit from repeated injections if the first two (2) injections do not offer relief. If epidural steroid injections provide relief, only in exceptional cases would more than three (3) injections be recommended within a three (3) month period. If pain becomes worse with an injection, repeating the procedure would be unnecessary.
With any procedure or injection there are risks. In the case of an epidural steroid injection these risks are small.
- The most common side effect is a temporary increase in pain. This occurs in about 1% of epidural steroid injections.
- Headaches are another complication with an incidence of 1% and may be related to the nonintentional puncture of the innermost membrane which surrounds the spinal cord. The headache is caused either by a leakage of the fluid surrounding the spinal cord, or as a result of the injection of air into the spinal fluid. In most cases, the headache subsides within a few hours. Sometimes, it may persist for days, rarely for longer. In a rare case of persistent headache, it may be necessary to repeat the epidural procedure and inject some of the patient’s own blood. This blood is taken from a vein in the arm and injected into the epidural space where it forms a small clot, which covers any puncture in the dural sac.
- Occasionally, patients exhibit an allergic response to one of the additives in the steroid solution. You may experience a hot blush or develop a rash. This should improve within a few hours or days.
- As with any procedure that penetrates the skin, there is a slight chance of introducing bacteria and causing an infection (this risk is minimized by performing the procedure within the surgery suite using sterile technique).
- It is also possible a nerve could be damaged during the procedure. When the needle is inserted, it is possible to brush up against the lining around the nerve. This would cause pain in the leg or arm. The doctor would then change the position of the needle slightly to avoid any risk of damage to the nerve.
- Your blood pressure may drop during the injection. The physician or assisting nurse would insert an intravenous needle and give you intravenous fluids or medication to control your blood pressure.
- Other rare, but documented side-effects of epidural steroid injections include: fluid retention, difficulty breathing, swelling of the face or other parts of the body, high blood pressure, irritation or damage to nerves of the lower or upper extremities, or pelvis.
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