Epidural Steroid Injection

 

What is an epidural steroid injection?

An epidural steroid injection is an injection of long-lasting steroid and local anesthetic placed under xray guidance into what is called the epidural space. This space is an area located near (but NOT in) the spine just outside of the sac containing spinal fluid. The goal of an epidural steroid injection is to provide pain relief by reducing the inflammation (swelling) of the nerve roots as they exit the spine. An epidural steroid injection will not cure the pre-existing medical problem (i.e. herniated or bulging disc, arthritis, spinal stenosis etc…) but it may improve the level of pain for a significant  period of time and in many cases reduce the need for costly and invasive spine surgery.  The injections are classically done in a series of three injections about 2-4 weeks apart if needed and generally can be repeated periodically to maintain pain relief. If the pain is significantly improved no further injection is needed unless the pain returns.

Can I get the epidural injection on my first visit?

Generally no–your first visit will be an initial clinic evaluation. The purpose of this evaluation is to review  your medical history , your medications, imaging studies, treatments already tried, and any other pertinent information. Please bring your records if at all possible. A physical exam will be performed and a plan of care will be formulated. If more information(such as records, imaging studies etc..) is required, we will assist you in obtaining it. If an epidural steroid injection is found to be an appropriate treatment it will be scheduled as soon as possible. Injections can only be done on the first visit if your insurer authorizes both an initial clinic evaluation and a procedure on the same day.

Are there any restrictions before the procedure?

You should bring an adult to accompany you to/from the procedure.  If you are having the procedure done at Odyssey Pain Center, we prefer that you do not eat/drink for at least 6 hours prior to the injection.   If you are having the procedure done under sedation in a surgery center/hospital, we require that you not eat or drink for at least 8 hours.  You should not be on any blood thinners(including but not limited to aspirin, ibuprofen, naprosyn, relafen, plavix, ticlid, coumadin, heparin, lovenox, fondaparinux, argatroban) before this procedure!  If you are on such medications or you are unsure if you are taking a blood thinner, you must alert all of your physician(s) and you should NOT undergo the procedure until it has been approved by your physician(s).  If you have fevers or an infection, we do not recommend undergoing the procedure until well after your infection resolves.  The procedure may be cancelled if any of the above directions are not followed.

What are the risks of the procedure?

Risks are rare but can occur.  The most common risk(1 out of 1000 or less in experienced hands) from an epidural steroid injection is what is called a “dural puncture”.  Such a puncture occurs when the needle’s tip unintentionally penetrates one layer deeper than the epidural space and subsequently punctures the layer that surrounds spinal fluid. If this occurs there is a risk of developing what is called a “spinal headache”, which may be severe and may last for days but generally subsides on its own. There is a highly effective treatment procedure called an “epidural blood patch” that can treat the headache if it occurs but does not improve on its own within a reasonable time period.

Other risks are rarer but include bleeding, infection, nerve injury and allergic reaction to the medication.

Other effects (that are expected) may occur. If local anesthetic(“numbing medicine”) spreads to nearby nerves you may have weakness or numbness that can last for 1 – 2 hours. If this happens you may have noticeable weakness of one or more extremities and you should not walk, drive or operate any machinery until this resolves. You may have increased pain at the injection site as well as your usual area of pain for the first few days after the injection. Patients with diabetes may have a short-term rise of blood sugar.  Some individuals may have increased fluid retention and hypertension.  Overly frequent usage of steroids can lead to long-term complications such as premature bone/muscle/tissue degeneration, cataracts, infections, hormone imbalances or deficiency.

Does the injection hurt?

Most people agree that the stinging/burning of the initial numbing medicine is the most uncomfortable portion of the procedure although individual response to the procedure will vary.

What happens during the procedure?

The back or neck is cleansed with an antiseptic to sterilize the area.  The doctor will utilize sterile protocols(gloves, drapes and other equipment) throughout the procedure. The skin is “numbed” with a local anesthetic by a very small needle. The epidural needle itself is then advanced into the epidural space usually under x-ray guidance. You may feel pressure throughout the procedure–if pain is felt, more local anesthetic will be given. Once in the epidural space the steroid is deposited and the needle is removed. Your skin will be cleansed and a bandage may be applied.  You will be allowed to leave with your ride after the doctor authorizes it.

What will I feel after the injection?

Most people do NOT notice any improvement immediately after the injection and, not uncommonly, the pain may actually be temporarily worsened. This is because the steroid takes at least two or three days to start to have an effect in most individuals. Therefore, it may be some time before you feel a change in your pain level!

Some local tenderness in the site of the injection should be expected for a couple of days afterwards. Using an ice pack three or four times a day may help this. You may take your usual pain medications as well after the injection.

Are there any restrictions after the procedure?

You should not drive or operate any machinery for the remainder of the day after your procedure. An adult should be present to drive you home.

No tub bath or soaking in water (i.e. pool, jacuzzi, etc.) for the remainder of the day.

You may eat, drink and take your medications as usual after the procedure unless told otherwise by your doctor.

You should contact your primary care physician to discuss when/if you should resume your usual medications(including blood thinners) if any.