What is an Epidural Steroid Injection?
The epidural steroid injection is the placement of steroid, a powerful anti-inflammatory agent, into the epidural space (spinal area on the surface of the spinal column). The main goal of the epidural injection is to decrease inflammation around disc and nerve irritation. Because of the low risk and low incidence of any significant problems or side effects, epidural injections are recommended to provide pain relief and enable patients to progress with their rehabilitation.
Epidural injections may be an effective nonsurgical option for common conditions such as lumbar disc herniation, degenerative disc disease, and lumbar spinal stenosis coordinated with physical therapy or other training once the injections have been completed. A large percentage of patients upon whom this procedure is performed will get complete resolution of symptoms; a small percentage may experience no real improvement at all. It is generally an accepted practice that this procedure be repeated up to three times within a few months, although in some cases, additional injections may be administered. Additional injections have additive effect.
How long does the procedure take?
You will typically be in the surgery center for approximately 2 hours. You will arrive one hour before the procedure. The actual procedure time is usually fifteen minutes. The remainder of the time will be spent in the recovery room.
What is actually injected?
The injection may consist of a mixture of local anesthetic (lidocaine or bupivacaine) and the steroid medication (triamcinolone, methylprednisolone, dexamethasone).
What are steroids?
Steroids are a certain form of chemical found naturally in your body. Medically used steroids are potent anti-inflammatory agents. They are useful in the treatment of patients with radiculopathy caused by local inflammation due to disc injury, degenerative changes, and other causes. Most adverse effects are associated with long-term use of steroids. When steroids are used locally with injections, the associated risks are substantially less. Side effects can include indigestion, increased appetite, trouble sleeping, and occasionally headache. Tylenol can help with headaches after a steroid injection or dosing.
Will I be “put out” for this procedure?
Patients’ have the choice of having local anesthetic administered or intravenous sedation and analgesia, which makes the procedure easier to tolerate.
What should I expect after the injection?
Immediately after the injection, you may feel that your arms or legs are slightly heavy and may be numb this will wear off gradually, this is due to the local anesthetic injected. This will last only for a few hours. You may have a “sore back” for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation form the steroid itself. You should start noticing pain relief starting the 3rd or 5th day or so.
What should I do after the procedure?
You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. Perform the activities as tolerated by you.
Can I go back to work the next day?
You should be able to unless the procedure was complicated. Usually you will feel some back pain or have a “sore back” only.
How long does the effect of the medication last?
The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The steroid starts working in about 3 to 5 days and its effect can last for several days to a few months.
How many injections do I need to have?
If the first injection does not relieve your symptoms in about a week to two weeks, we may recommend that you have one more injection. Similarly If the second injection does not relieve your symptoms in about a week to two weeks, you may be recommended to have a third injection.
Can I have more than three injections?
In a six month period, we generally do not perform more than three injections. This is because the medication injected lasts for about six months. If three injections have not helped you much, it is very unlikely that you will get any further benefit from more injections.
What are the risks and side effects?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain – which is temporary. Other risks include possible infection, nerve damage, headaches and possible side effects due to steroid such as increase in blood sugar (mainly in diabetics), water retention, and suppression of body`s own natural production of cortisone.