What is Epidural Steroid Injection Therapy?
Epidural refers to the space outside the dura or covering of the spinal cord and inside the spinal canal. This space runs the length of the spinal cord. Epidural injections provide diagnostic data and pain relief by delivering a local anesthetic and anti-inflammatory action of steroid into the spinal area on the surface of the spinal column. The procedure is done under fluoroscopy (X-ray) guidance so your doctor can better target the direct source of your pain. Learn more by contacting Southwest Spine & Sports in Scottsdale, AZ, to schedule your initial consultation with our skilled team.
What are Steroids?
Steroids are a certain form of a 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 a 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.
Examples of Disc Problems
Inflammation or irritation of a nerve root most commonly originates from a herniated, degenerated, or “leaky” disc at that spinal nerve root level.
- Degenerated Disc
- Bulging Disc
- Herniated Disc
- Thinning Disc
- Disc Degeneration with Osteophyte Formation
What are the different types of Epidural Spinal Injections?
- Caudal epidural injection: Caudal is the Latin word signifying the tail or tail end of the spine. Thus, a caudal injection is a location where the epidural steroid is placed. The spinal needle is introduced through a portion of the sacrum. A small bony opening, called the sacral hiatus, is entered with the spinal needle under x-ray guidance. This technique is often preferred in patients who have had previous surgeries causing scar formation that would interfere with injection at other locations. It is also sometimes the preferred place of injection for patients with spinal stenosis. This is a relatively safe, easy procedure to perform and can provide significant anatomical coverage of the injected medications. It is not one of the more specific, localizable procedures.
- Transforaminal epidural injection: A transforaminal epidural steroid injection (selective nerve root block) is a procedure performed for both diagnostic and therapeutic purposes for neck/back pain and limb pain, numbness, tingling, or weakness. In this procedure, a needle is directed under fluoroscopic (x-ray) guidance through the foramen or opening where the spinal nerve exits at the level where the disc and nerve injury has occurred. The medication – anesthetic and steroid – is delivered specifically between the disc and nerve interface and along the course of the nerve which is causing the majority of the symptoms.
- Interlaminar (translaminar) injection: An interlaminar epidural steroid injection is an approach in which a needle is advanced to a site-specific to the injury. The level of injury is viewed under fluoroscopy, and the needle is advanced between two vertebrae to a depth that puts it in the epidural space. Please see the anatomy pictures for full details. The epidural space is a space overlying the spinal cord. As the needle advances, it goes past the bony shelves of the back portion of the vertebrae and stops before entering the spinal cord or spinal space. The injected material is placed over this region to then bathe the areas of interest.
What are the benefits of epidural steroid injections?
There are several benefits of epidural steroid injections, including:
- Reduced inflammation
- Alleviation of pain
- Improved mobility
- Customized treatment options
- Decreasing the potential of needing surgery
How do epidural steroid injections work?
You will typically be in the surgery center for approximately two 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.
The procedure does involve an injection — so you may feel some discomfort. Local anesthetic is used, and intravenous medication may be given to make you as comfortable as possible. You may feel some warmth as the fluid is injected. You may also experience some of your typical pain. The doctor will be interested in how this compares to your usual symptoms.
You may experience numbness and/or relief from your typical pain for up to six hours after the injection. This is due to the long-acting anesthetic injected. Your usual symptoms may then return and may be worse than usual for a day or two. The beneficial effects of the steroid injection usually begin in 2 – 3 days or may take as long as a week.
It is hard to determine exactly. If an initial injection provided a certain amount of pain relief, a second injection may provide additional benefit. If your pain subsides completely and does return at some point, additional injections may be an option.
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What are the risks of this procedure?
Generally speaking, this procedure is very safe. However, as with any procedure, there are risks, side effects, and the possibility of complications. The most common side effect is pain, which is temporary.
There is also occasional bruising. There is a slight possibility of infection, either at the site of injection or in the deeper tissue. This could require the use of antibiotics, either by mouth or intravenously. Additionally, if the infection were severe, it could require hospitalization and further surgery.
In these procedures, it is possible to get close to a nerve root, and this would cause a slight increase in pain with possible radiation into the limb. It is very unlikely, but there could be permanent nerve damage.
Very rare complications may include bone injury from repetitive steroid intake, reaction to the injectant (anesthetic or steroid material) causing respiratory or cardiac compromise, as well as seizures. Death is even a possibility, as with any invasive procedure, although this possibility is exceedingly rare.
Steroid medications have rarely been associated with hip or arm (bone) damage, and this has usually been with high doses or prolonged use. This remains a rare complication.
Epidural Steroid Injections FAQ
Do epidural steroid injections hurt?
No, most patients don’t find an epidural steroid injection painful, although some may find it uncomfortable. Before we begin, the target area will be completely numbed with a local anesthetic to prevent pain and we also offer IV medication to further ensure you’re comfortable.
How long does it take to get an epidural steroid injection?
Typically, patients will be in the surgery center for two hours to get an epidural steroid injection; however, the actual injection procedure is only about 15 minutes. The rest of the time you will be relaxing in the recovery room.
When will I get relief after an epidural steroid injection?
Most patients will get relief in about 2 – 7 days after their epidural steroid injection.
How long do the effects of an epidural steroid injection last?
How long the benefits of an epidural steroid injection last will depend on a number of factors including your condition, health, age, and lifestyle. Generally, patients can achieve relief that lasts for weeks or months, and even up to one year.
How Epidural Steroid Injections can help you
In general, epidural injections are recommended to provide pain relief and enable patients to progress with their rehabilitation. Epidural injections may be an effective non-surgical option for common conditions such as lumbar disc herniation, degenerative disc disease, and lumbar spinal stenosis. Contact our skilled team in Scottsdale, AZ, to learn more and schedule a consultation for epidural steroid injections.