Epidural Steroid Injection

Epidural steroid injection is the placement of cortisone, a powerful anti-inflammatory agent, into the epidural space, which lies next to the disc and spinal cord. The epidural steroid injection has been used for over 40 years as treatment for back pain. It involves using either steroids or anesthetic agents allowing good benefits with minimal risk factors. The main goal of the epidural injection is to shrink the swelling in bulging or herniated discs, and to decrease any inflammation that surrounds the disc and nerve root.

Because of the low risk and low incidence of any significant side effects, this is felt to be a reasonable procedure to follow when traditional conservative therapy for disc pain has failed to provide improvement. A large percentage (60-90%) of patients upon whom this procedure is performed will get significant improvement of symptoms; a small percentage may experience no real improvement at all. It is generally an accepted practice that this procedure be repeated up to three times within a year, although in some cases, additional injections may be administered. Injections may be given as a single dose, or given every two weeks up to three injections or until symptoms are gone. If no improvement is seen after two injections, then addition treatments may be considered.

Side effects and adverse reactions are rare. Some of these potential (uncommon) side effects include fluid retention. The most common side effect is local tenderness around the injection site. We ask that you rest the day of your injection and ice the area 20 minutes every hour for the first day. Other risks involve infections and bleeding. We cannot inject you if you are on antibiotics, have an infection or are running a fever. You should be afebrile for 48 hours after completing your antibiotics before we can proceed with your injection. You cannot receive an injection if you have been on aspirin or other blood thinners. You must be off of blood thinners 7 days before we can inject you. If your doctor has put you on these medications, then we must get approval in writing before we can proceed. If you are on Coumadin, then we must get written approval from your doctor and have your PT/ INR normal before we can inject you. An additional risk is the possibility that the epidural needle may nick the dura (the covering of the spinal cord). Should this occur, there could be leakage of cerebrospinal fluid, which could cause a severe “spinal headache.” If this should happen, bed rest and an increase in fluid and caffeine intake frequently will alleviate the headache completely. Should this not resolve the problem, it could be necessary to do what is called a “blood patch”, in which (under sterile conditions) blood is removed from a vein in the arm and placed into the same epidural space. This completely resolves symptoms of the headache. The incidence of a spinal headache is approximately 1 in 1,000. Other rare, but serious side effects may include: worsening of symptoms, allergies from the dye that we use, bleeding, infection or epidural abscess, backache, steroid side effects, bowel or bladder dysfunction, hematoma, cord compression, avascular necrosis, paralysis, neurological damage or impairment, or death. In order to avoid these complications, the procedure is done under strict sterile conditions, utilizing fluoroscopy to localize the epidural space and guide the needle.

If there is improvement from the steroid epidural, it likely will occur over the next several days to two weeks. The improvement should not be expected immediately. Patients are advised to rest on the day of the epidural, although bed rest is not required. By the next day, previous activities can be resumed. An occasional patient will feel such significant relief that they are tempted to resume various strenuous activities. They are cautioned not to do this, however. It is generally advised to pursue a course of gradual increase in activity, often coordinated with physical therapy or other training once the injections have been completed.

Patients are usually seen 14 days following the procedure for a follow-up exam, to evaluate their response to the steroid epidural(s) and to discuss if further injections are necessary.

If you have worsening in your symptoms; increase numbness in your extremity, fever, severe headache, or bowel or bladder incontinence, please call your physician immediately.