Epidural Corticosteroid Injection

What is an epidural corticosteroid injection?

An epidural corticosteroid (steroid) injection is a way to deliver pain medicine quickly into the body with a syringe. The medicine is injected into the epidural space in your spine. Epidural space is a fat-filled area that covers the spinal cord and the surrounding nerves and protects it from damage.

Pain relief from this procedure can be short lasting for few weeks to longer lasting for several months.

Why might I need an epidural steroid injection?

If you have intense, difficult-to-treat pain in your legs or arms from inflamed spinal nerves, then an epidural steroid injection might give you quick relief. Often, nerve passages from the spine to your arms or legs become narrowed, causing this pain. This narrowing can cause inflammation of the spinal nerves.

Several conditions may add to this narrowing, including :

Herniated disks
"Slipped" vertebrae
Facet Joint cysts
Bone spurs
Thicken ligaments in the spine because of spinal arthritis

Injected steroids reduce inflammation and opens up these passages to provides pain relief.

What are the risks of an epidural steroid injection?

An epidural steroid injection generally causes no problems. If you do have side effects, they may include:

"Steroid flush," or flushing of the face and chest, with warmth and an increase in temperature for several days
Sleeping problems
Anxiety
Menstrual changes
Water retention
In rare instances, pain that increases for several days after the procedure

Serious complications are rare but can include :

Allergic reaction
Bleeding
Nerve damage
Infection
Paralysis

How do I get ready for an epidural steroid injection?

Tips for preparation include the following :

• An epidural steroid injection is generally an outpatient procedure. You may be asked to wear loose fitting clothes or to change into a surgical gown to make the injection process easier.
• The procedure is performed under local anesthesia, or you may receive mild sedative.
• If you are on any blood thinners or aspirin products such as Bayer’s or BC powder or goody’s or NSAIDs (Advil, Motrin, Aleve, ibuprofen), you should discuss with your provider. You may be asked to stop above medicines based on type of procedure. Do not stop your medicine without consulting your physician.
• If you have diabetes, an allergy to contrast dye or cortisone or local anesthetics, or certain other medical conditions, you should discuss your concerns with healthcare provider before the procedure.
• If you have any active infection or fever, you should inform your doctor before proceeding with procedure.

Based on your medical condition, your healthcare provider may request other specific steps.

What happens during an epidural steroid injection procedure?

An epidural steroid injection is a simple procedure:

1. Your healthcare provider will use a real time X-ray machine showing moving images on a screen to guide the needle and ensures that the needle is in the correct location.
2. Contrast dye is injected at the site to make sure that the medicine will be sent to the exact place it needs to go.
3. The healthcare provider will inject the cortisone with local anesthetic to help with pain relief.

What happens after an epidural corticosteroid injection procedure?

Once the procedure is done, you should return home and avoid unnecessary walking for the same day. You should have a driver for safety reason. It is not advisable to drive on same day after the procedure. Usually, you'll be able to return to normal activities on the next day.

If you are diabetic, you should monitor your blood sugar levels closely for first few days. You might want to reach out to your provider for further help if needed.

If you develop any redness or discharge from procedure site or have any fever, contact your doctor as soon as possible, or seek for emergency care.

The cortisone usually begins working within 3-5 days and it can take up to 2-3 weeks for full benefit.

Many people get several months of improvement of pain and function from the injections. If the injection is effective, it can be repeated. If you have any side effects, be sure to contact your healthcare provider.

If you don't have pain relief, talk with your healthcare provider. Sometimes it takes series of injections to achieve significant pain relief, or this may be a sign that the pain is coming from some place other than the spinal nerves.