Epidural Steroid Injection

An epidural steroid injection is given to relieve pain in the neck, back, or legs. This procedure involves injecting a steroid and numbing medicine (local anesthetic) into the epidural space. The epidural space is the space between the outer covering of the spinal cord and the vertebra. The epidural steroid injection helps in reducing the pain that is caused by the irritation or swelling of the nerve root. However, it does not cure the underlying problem. The injection may be given for the following conditions:

  • Changes in the soft, gel-like cushion between two vertebrae (disk) due to wear and tear.

  • A reduction in the space within the spinal canal.

  • Slipped or herniated disk.

  • Low back (lumbar) sprain.

  • Sciatica. This is shooting pain that radiates down the buttocks and the back of the leg due to compression of the nerve.

  • Traumatic compression fracture of the vertebra.

  • Pain that develops after a surgery of the spine.

  • Pain that arises after an attack of viral infection affecting the nerves (shingles).

LET YOUR CAREGIVER KNOW ABOUT:

  • Allergies to food or medicine.

  • Medicines taken, including vitamins, herbs, eyedrops, over-the-counter medicines, and creams.

  • Use of steroids (by mouth or creams).

  • Previous problems with anesthetics or numbing medicines.

  • History of bleeding problems or blood clots.

  • Previous surgery.

  • Other health problems, including diabetes and kidney problems.

  • Possibility of pregnancy, if this applies.

RISKS AND COMPLICATIONS

The complications due to the needle insertion are:

  • Headache.

  • Bleeding.

  • Infection.

  • Allergic reaction to the medicines.

  • Damage to the nerves.

The complications due to the steroid are:

  • Weight gain.

  • Hot flashes.

  • Mood swings.

  • Lack of sleep.

  • Increase in blood sugar levels, especially if you are diabetic.

  • Retention of water.

The response to this procedure depends on the underlying cause of the pain and its duration. Patients who have long-term (chronic) pain are less likely to benefit from epidural steroids than are patients whose pain comes on strong and suddenly.

BEFORE THE PROCEDURE

  • The caregiver may ask about your symptoms, do a detailed exam, and advise some tests. These tests may include imaging studies. Your caregiver may review the results of your tests and discuss the procedure with you.

  • Ask your caregiver about changing or stopping your regular medicines. You may be advised to stop taking blood-thinning medicines a few days before the procedure.

  • You may also be given medicines to reduce your anxiety.

PROCEDURE

You will remain awake during the whole procedure. Although, you may receive medicine to make you sleepy. You will be asked to lie on your stomach. The site of the injection is cleansed. Then, the injection site is numbed using a small amount of medicine that numbs the area (local anesthetic). A hollow needle is directed through your skin into the epidural space with the help of an X-ray. The X-ray helps to ensure that the steroid is delivered closest to the affected nerve. You may have some minimal discomfort at this time. Once the needle is in the right position, the local anesthetic and the steroid are injected into the epidural space. The needle is then removed. The skin is cleaned and a bandage is applied. The entire procedure takes only a few minutes, although repeated injections may be required (up to 3 to 4 injections over several weeks).

AFTER THE PROCEDURE

  • You may be monitored for a short time before you go home.

  • You may feel weakness or numbness in your arm or leg, which disappears within 1 to 2 hours.

  • Someone must drive you home or accompany you home if you are taking a taxi.

  • You may be allowed to eat, drink, and take your regular medicine.

  • Your pain may improve or worsen right after the procedure.

  • You may feel the beneficial effect of the steroid a few days later.

  • You may have soreness at the site of the injection.

  • If you have only partial relief of the pain, the injection may be repeated once or even twice within 4 to 8 weeks of the initial injection.