What is an epidural steroid injection?
An epidural steroid injection (ESI) is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves. ESI may be performed to relieve pain caused by spinal stenosis, spondylolysis, or disc herniation. An epidural injection places anti-inflammatory (corticosteroid) medicine and an anesthetic numbing agent into the epidural space to decrease inflammation of the nerve roots, hopefully reducing your pain. The effects of ESI tend to be temporary. Pain relief may last for several days or even years although some may not receive relief at all. The goal is to reduce pain so that you may resume normal activities and a physical therapy program.
What will happen to me during the procedure?
An IV will be started so that mild sedation can be given. You will be positioned in such a way that your doctor can best visualize the area to be injected. The skin on your back or neck will be scrubbed using sterile soap. Next, the physician will numb a small area of skin where the epidural needle will be placed. This medicine stings for several seconds. After the numbing medicine is working, your doctor will direct a small epidural needle using x-ray guidance into the epidural space. A small amount of contrast (dye) is then injected to insure proper needle position in the epidural space. Then, a mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) will be injected.
There are three ways to deliver epidural steroid injections: translaminar, transforaminal, or caudal approaches. The best method depends on the location and source of pain.
1. Translaminar ESI: The needle is placed between the lamina of two vertebrae directly from the middle of the back. Also called interlaminar, this method accesses the large epidural space overlying the spinal cord. Medication is delivered to the nerve roots on both the right and left sides of the inflamed area at the same time.
2. Transforaminal ESI: The needle is placed to the side of the vertebra in the neural foramen, just above the opening for the nerve root and outside the epidural space. Use of a contrast dye helps to confirm where the medication will flow when injected. This method treats one side at a time. It is preferred for patients who have undergone a previous spine surgery because it avoids any residual scars, bone grafts, metal rods, and screws.
3. Caudal: The needle is placed through a small opening in the caudal canal at the base of the spinal canal just above the tailbone. Local anesthetic is given into the skin and the tissues below the skin to reduce the pain of needle entering into the caudal canal. Use of a contrast dye helps to confirm where the medication will flow when injected.
What will happen after the procedure?
You will go back to the recovery area where you will be monitored for 30-60 minutes. You may experience some numbness and/or weakness into your legs or arms for a few hours. The steroids will begin working 3-5 days after the procedure and may continue to improve your pain for up to fourteen days or it may last weeks, months or even years. You should make a follow up appointment with your referring physician 2 weeks after the procedure to determine if further treatment is needed. These injections are often performed in a series of three (3) to provide the best possible results.
General Pre/Post Procedure Instructions:
You should not eat or drink anything after midnight the night before the procedure. If you are a diabetic, do not take your insulin or oral medication the morning of the procedure because you have had nothing to eat. If you are taking routine heart or blood pressure medicine, you should take it with a sip of water the morning of the procedure. You should not take medications that may give pain relief or lessen your usual pain. These medicines can be restarted after the procedure if they are needed. If you are on Coumadin, Heparin, Plavix, or other blood thinners (including aspirin and all medications that contain aspirin), you must notify the office well in advance so the timing of these medications can be coordinated with your primary physician. You will be at the hospital for a few hours for your procedure. A responsible driver (over the age of 18) must accompany you and be responsible for driving you home. No driving is allowed the day of the procedure. You may return to your normal activities the following day, including returning to work.