Epidural Steroid Injection

Anatomy

Vertebrae (bone), discs (cushions between the bones), and the spinal cord with nerve roots comprise the deep portion of your neck and back. There are joints between each vertebrae

• Cervical (neck): 7 vertebrae, 8 nerves
• Thoracic (mid-back): 12 vertebrate, 12 nerves
• Lumbar (low back): 5 vertebrate, 5 nerves
• Sacrum and coccyx (tailbone)

Epidural Approach

There are two approaches for epidural steroid injections. Epidural injections place medications outside the spinal cord. The needle does not penetrate the spinal cord. Intralaminar epidural injections are single shots. Tranforaminal epidural injections target nerve roots.

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Potential Benefits of the Epidural Steroid Injection

These injections are indicated for neck, mid-back, or low back pain, often times with arm or leg pain. Steroids will not change the structural issue in your spine, but it can decrease inflammation and break the pain cycle.  Epidural steroid injections deliver medication near the source of your pain generator. In comparison, oral steroids and painkillers have an effect on your entire body.

Potential Risks of the Epidural Steroid Injection

Overall, steroid injections are very-well tolerated.

• With any injection (even the flu shot), there is a risk of: pain, infection, bruising, damage to skin/muscles/nerve.  Temporary numbness/tingling down the legs can occur from the local anesthetic.
• Headaches may occur in certain patients; this, too, will resolve.
• Steroid side effects: allergies, “steroid flush” (warm face), anxiety, mood change, change in menstrual cycle, weight gain. All temporary.

• Extremely rare: Loss of vision, stroke, paralysis, and death are possible complications of any injection near the spine or the brain. Xray guidance is used to avoid this.
• Let me know if: you have diabetes, osteoporosis, have a compromised immune function, or have an allergy to contrast dyes or steroids.

How effective is an Epidural Steroid?

When you have a sudden pain flare, inflammatory chemicals are released. Epidurals can reduce this inflammation. The long term effects of getting epidural steroid injections continues to be debated.  Some studies don’t select a precise patient population, some include procedures without fluoroscopic guidance, and some have inexperienced professionals doing the injections. Clinically, at least 50% of the patients our in the community who do get epidural steroid injections do get noticeable pain relief. If you are an appropriate candidate, this number is higher.

Before your Epidural Steroid Injection

• Stop anti-inflammatories or anticoagulation (blood thinner) medications as discussed.
• No eating or drinking prior to your procedure as discussed.
• Each patient/case is a little different, so please follow instructions specific to you.
• Relax – it will all be fine. Set a reward for yourself, like a delicious meal.

After the Epidural Steroid Injection

• Eat, drink and be merry.
• No bathing, hot tubbing, immersing in water for 24 hours.  Showering is fine.
• Resume medications as discussed.
• The local anesthetic (numbing medication) will wear off in a few hours. Give the steroid 2-7 days to kick in. Resume your home exercise program, physical therapy and life enjoyment as soon as you can.