Why Do I Need An Epidural Steroid Injection?

If your doctor has recommended an epidural steroid injection it is because there are signs that you have an area of inflammation within the spine that is producig pain and decreasing your ability to function, Most commonly this inflammafion surrounds a damaged spinal disc. Other causes of inflammation include arthritic spinal joints, acute strain of spinal muscles or ligaments, and degenerative changes of the spine caused by aging or osteoporosis.

These problems may occur at any level in the spine, but most commonly happen where stress in the spine is the greatest: at the base of the neck or the low back. Often the inflammation is close to a spinal nerve, causing pain to radiate to the arm or leg. Sometimes leg or arm pain is the only symptom with no back or neck pain at all!

Your doctor may have already obtained an MRI or CT scan of your spine which shows the probable cause of the pain. You may have also been treated with muscle relaxers and anti-inflammatory medications, which may not have been effective in controlling your symptoms to the point where you could comfortably perform daily activities or participate in physical therapy. If this is the case, the next step in your treatment is usually an epidural steroid injection.

How Does It Work?

Certain steroid drugs (drugs related to cortisone) possess strong anti-inflammatory properties. When injected around the inflamed nerve, disc, or ligament, these drugs can stop inflammation and relieve pain, To place this medication as close as possible to the site of the inflammation, it is injected into a region of the spine called the epidural space. This space lies inside the spine between the inner surfaces of the bones of the spinal canal and the membrane covering the spinal cord, When medication is injected in this space, it spreads out to surround the spinal nerves and the surfaces of the discs and joints near the site of injection.

Reduction of inflammation and pain usually occurs within 24-48 hours after inhection. In some cases, it may take a little longer.

How Is It Performed?

You are first placed in a relaxing sitting position or comfortably on your side. Your doctor will locate the appropriate space between the vertebrae and numb the skin around that area with a local anesthetic. A needle is then inserted and advanced about two inches until its tip reaches the epidural space. The ligament between the vertebrae through which the needle passes contains no nerves, so the needle placement is virtually painless. X-ray guidance of needle placement may be needed if you have had previous back or neck surgery. The procedure lasts 10 minutes on average.

After the procedure you may feel numbness or mild weakness of the legs or arms. This is due to the local anesthetic and may last 2-3 hours. You should not drive yourself home. You can resume your usual duties the following day.

How Many Are Needed?

Usually, two injections effectively reduce inflammation around damaged tissue, allowing decreased pain and increased activity while the tissue is healing. Although in most cases the injured disc, strained muscle or arthritic joint will heal on its own, a physical therapy program is often needed to strengthen and condition the muscles of the trunk or neck, stabilize the spine and reduce the risk of re-injury. In this case you should think of the epidural steroid injection as providing a "window of opportunity" for you to successfully complete the physical therapy process. Coordinating physical therapy with the injections is important so that the window does not close before therapy is completed.

If you have osteoporosis or chronic arthritis of the spine, repeated epidural steroid injections may be needed over a long period of time. These can be safely repeated every four to six months.

What Are The Possible Side Effects And Risks?

In general, there are few side effects from the steroid medication because the dose is small and carefully controlled. Diabetics should be aware that blood sugar levels may rise temporarily following the injection.

The risk of nerve damage, infection or other serious complications is less than one in ten thousand. There is about a one in one hundred (1%) chance of having a spinal headache after the procedure. This is not a dangerous complication, but the headache may be severe and may last several days.

If you have any other questions or concerns, your doctor will be happy to answer them before the procedure.