The epidural steroid injection (ESI) is used to decrease pain and inflammation of the spinal nerves and associated spinal structures. This treatment is highly effective for relief of low back pain related to nerve inflammation.
The epidural steroid injection is used for treating many spinal conditions, such as:
Degenerative disc disease
The ESI involves the injection of a long-acting steroid (triamcinolone or betamethasone). The pain specialist may also choose to inject an anesthetic, such as lidocaine or bupivacaine. The drugs are instilled directly into the epidural space, which lies between the vertebra and the dural covering.
Corticosteroids reduce inflammation of the nerves and associated spinal structures. They do not reverse damage to the spinal column or reduce the herniated disc. The pain relief lasts for weeks to months.
The epidural steroid injection will take around 20-30 minutes. When the patient arrives at the pain management center, a nurse will go over the risks and benefits and have the patient sign a consent form. In addition, the nurse will place an IV catheter in the patient’s arm. Arrange to have someone drive you home, as a mild sedative may be used.
The doctor positions the patient on his or her stomach, and uses an antiseptic agent to numb the skin. To guide the needle into the correct position, live x-ray (fluoroscopy) is used. If necessary, the doctor uses normal saline to flush out inflammatory proteins from the epidural space. The corticosteroid is injected, with or without an anesthetic, and the surgical site is covered with a bandage.
After the procedure, the patient is monitored for around 20 minutes before being discharged. Normal activities can usually be resumed the following day. A nurse will instruct the patient on post-procedure care.
The epidural steroid injection is usually successful in relieving back pain for the majority of patients. Clinical studies show this procedure has a 70-90% efficacy rate. Because one ESI may not be effective, the doctor may schedule a series of three injections for maximum effects. The epidural steroid injection will offer pain relief for approximately 6-12 weeks.
While the ESI is a minimally invasive medical procedure, there are some potential risks and complications. These include:
Bleeding – This rare complication is common for people with underlying bleeding disorders.
Infection – While severe infections are rare, minor infections occur in around 1% of patients.
Dural puncture – This is where the dural sac surrounding the spinal cord is punctured, which causes a post-dural puncture headache (PDPH). This requires a blood patch to repair.
Nerve damage – This is a rare occurrence that is the result of direct trauma from the needle.
Side effects to the corticosteroid include high blood sugar, transient skin flushing, increased appetite, a decrease in immunity, and slight weight gain.
The ESI should not be performed on patients who: