Epidural Steroid Injection
An epidural steroid injection is a procedure in which your physician uses a small needle to inject a steroid (like cortisone) into the epidural space, which is the space that surrounds your spinal cord.
Frequently Asked Questions
The purpose of an epidural steroid injection is to reduce the swelling and inflammation of irritated nerves as they leave the spinal cord. Irritated nerves can cause symptoms such as pain, tingling, numbness, or loss of strength.
The actual injection only takes a few minutes. You can expect to be in the procedure room for about 15 minutes for positioning, placing monitors, preparation, and the procedure.
The injection usually consists of the corticosteroid (methylprednisolone, triamcinolone, celestone) and a local anesthetic (lidocaine or bupivicaine).
Most patients tolerate the injection very well. Numbing medicine is placed under the skin that feels like a poke and a burn. After that, you most likely will only feel pressure. If you feel any pain during the injection, more numbing medicine can be given. If you choose, you may have intravenous sedation to help you relax.
You will be lying on your stomach on an x-ray table. We will monitor your blood pressure, heart rhythm, and blood oxygen. Your skin will be cleansed with an antiseptic. After the injection, you will be placed on a bed and moved to the recovery area.
You may or may not feel better immediately after the injection and your legs or arms may feel slightly heavy or numb. The numbing medicine injected can wear off after several hours. You may have a sore back or neck for several days after the injection. This is due to the needle insertion as well as the chemically irritating effect of the steroid. The steroid is a long and slow acting medication that can take up to 5 days before starting to work and up to 2 weeks before taking full effect.
We recommend that you limit strenuous physical activity the day of the injection. You will bring someone with to drive you home the day of the injection. There is absolutely no driving the day of the injection. You may go about your normal daily activities as tolerated excluding strenuous physical activity.
The effect of the steroid can last anywhere from several days to several months. The purpose of the injection is to decrease swelling and inflammation to decrease pain. Over time, your body may heal itself.
If the first injection does not relieve your symptoms after two weeks, a second injection may be recommended. If the second injection doesn’t relieve your symptoms after an additional two weeks, a third injection may be recommended. The effects of the injections are additive if spaced at these time intervals. We generally would not perform more than 3 epidural steroid injections in a 6-month time period. More than this may increase the steroid load in your body increasing the likelihood of suffering from side effects. If 3 injections did not provide a lasting benefit, it is unlikely that any further epidural steroid injections would provide further benefit.
Overall, epidural steroid injections have about a 60% success rate and treating pain. Your chance of improvement will be better if your pain is less than 6 months old, is more in your legs or arms than back, and you have not had previous back surgery.
Overall, the procedure is very safe. As with any procedure, there are risks. The most common side effect is pain, which is temporary. Any time a needle is punctured through the skin, there is a chance of bleeding or infection that is very rare. Other rare side effects include spinal headache, nerve damage, worsening of pain, etc., which are extremely unlikely
If you are allergic to corticosteroids, specific local anesthetics, or ionic contrast, please notify your physician. Also, if you are taking any blood thinners (Coumadin, Plavix, Warfarin, Lovenox, Aspirin) please let your physician know ahead of time to help devise a safe plan for the injection.