Epidural Steroid Injections

FAQ’s on Epidural Steroid Injections

What is an epidural steroid injection?

The epidural steroid injection is a technique that has been used since 1952 to relieve the symptoms of spinal nerve-related pain. This is used as one of the conservative, non-surgical interventions for various conditions that lead to pain from the inflammation and irritation of the spinal nerves. While the goal of epidural steroid injections is primarily pain relief, it can also be used as part of a comprehensive physical therapy and rehabilitation program. This technique has been shown to be as effective as other, more invasive, modalities and should be considered.

The injection of epidural steroids is usually accompanied by local anesthetics, which afford relief from pain that usually lasts anywhere from one week to a whole year. This makes it very useful in dealing with severe, acute attacks of pain. If you find the therapy effective, then you may receive up to three or four in a one-year period.

How does an epidural steroid injection work?

The epidural space is also known as the “extradural space”. It is the anatomic space on the outermost part of the spinal canal, lying outside the dura mater. This space contains the spinal nerve roots, fatty tissues, blood vessels such as small arteries, the epidural venous plexus, and some lymphatics.

With an epidural steroid injection, steroids are delivered directly into the epidural space. Commonly used steroids are dexamethasone, methylprednisone, and other corticosteroids. These steroids relieve pain by inhibiting the inflammatory response or by relieving the inflammation that causes nerve root irritation and swelling. Thus, the mechanical and chemical sources of pain are relieved.

What are the conditions that can be treated with epidural steroid injections?

Epidural steroid injections are most effective when used to treat conditions that cause nerve irritation. These include:

The procedure should be avoided if you have any of the following conditions:

How is the epidural steroid injection procedure performed?

The procedure is usually done under a local anesthetic. The sterile technique is observed, and the surgical site will be prepped with antiseptic solution, while the rest of the non-surgical area will be draped with sterile linen. You may be given a mild sedative to help you relax and allow the procedure to continue smoothly.

The operation begins when the surgeon inserts the needle into the injection site. There are two recommended approaches: caudal and transforaminal, the latter approach associated with less radiation exposure from fluoroscopy guidance. When the end of the needle reaches the epidural space, a local anesthetic and the steroid is injected.

The patient will be monitored for 20 to 30 minutes after the procedure before being sent home.

What are the success rates?

Success rates are typically high for this procedure. Studies have shown relief of symptoms for more than 80% of those undergoing the procedure for lumbar disc herniation, while 75% of patients undergoing the procedure for spinal stenosis report more than 50% reduction in pain over one year.

There are risks with the procedure, and you should be aware of the potential for infection, or injection into the dural space, causing weakness.

References

Botwin, KP et al. Fluoroscopically guided lumbar transforaminal epidural steroid injections in degenerative lumbar stenosis: an outcome study.Am J Phys Med Rehab. 2002. 81(12): 898-905.

Kim HJ, Rim BC, Lim JW, et al. Efficacy of epidural neuroplasty versus transforaminal epidural steroid injection for the radiating pain caused by a herniated lumbar disc. Ann Rehabil Med. 2013;37(6):824-31. doi: 10.5535/arm.2013.37.6.824.

Manchikanti L, Singh V, Cash KA, Pampati V, Falco FJ. A randomized, double-blind, active-control trial of the effectiveness of lumbar interlaminar epidural injections in disc herniation. Pain Physician. 2014;17(1):E61-74.

Kim SJ, Lee MH, Lee SW, Chung HW, Lee SH, Shin MJ. Radiation Exposure for Fluoroscopy-guided Lumbosacral Epidural Steroid Injections: Comparison of the Transforaminal and Caudal Approaches. J Spinal Disord Tech. 2014;27(1):E37-40. doi: 10.1097/BSD.0b013e31829eb80f.

Kim SJ, Lee MH, Lee SW, Chung HW, Lee SH, Shin MJ. Radiation Exposure for Fluoroscopy-guided Lumbosacral Epidural Steroid Injections: Comparison of the Transforaminal and Caudal Approaches. J Spinal Disord Tech. 2014;27(1):E37-40. doi: 10.1097/BSD.0b013e31829eb80f.