Epidural steroid injections, or ESIs, are a minimally invasive treatment that has been used for decades to temporarily relieve low back and leg pain (sciatica). They have been shown to be effective for pain in the neck (cervical) and mid-spine (thoracic) as well. While they do not treat serious underlying spinal conditions, ESIs are often effective in relieving the chronic pain these conditions often cause.
Comprised of cortisone and a local anesthetic or saline solution, ESIs work by reducing inflammation and flushing out particles that cause swelling and pain. Medication is delivered directly to the source of the pain rather than dispersing it throughout the body, as oral painkillers and steroids do. They are injected into the epidural space, the area between the dura (a membrane covering the brain and spinal cord) and the actual cord itself.
Candidates for Epidural Steroid Injection
Epidural steroid injections can be used to relieve pain within the lower back, arms, legs and neck, which may be caused by conditions such as:
- Lumbar disc herniation
- Degenerative disc disease
- Lumbar spinal stenosis
- Vertebral compression fractures
- Facet joint or nerve root cysts
- Annular tear
Epidural steroid injections can be used alone to provide pain relief or given as part of a rehabilitation program to help the patient perform his/her exercises with less discomfort. Relief from a single injection typically lasts from one week up to one year. These injections can also be of diagnostic value to determine the cause and severity of pain and develop an appropriate treatment plan.
While this treatment is considered safe for most patients, it should not be performed on those who are pregnant, have an infection or have bleeding problems. It may also elevate blood pressure and blood sugar levels temporarily, so those with related conditions should take precautions.
Epidural Steroid Injection Procedure
Epidural steroid injections are usually administered by an anesthesiologist in an outpatient facility. The injection can be painful, and may only benefit 30% to 70% of patients, but is often beneficial when other pain relief treatments have failed. Local anesthesia may be applied prior to the injection to numb the area. Dr. Lipani will likely administer this treatment under x-ray guidance to ensure precise placement of the treatment needle. The medication is delivered directly into the epidural space and can be watched through fluoroscopy to make sure it reaches the inflamed nerve root.
This procedure takes just a few minutes to perform, with most patients experiencing more pressure than pain. You will likely experience immediate pain relief due to the applied anesthetic, which will wear off within a few hours. Applying ice and taking Tylenol can help relieve any pain at the injection site.
Recovery and Results from Epidural Steroid Injections
After the epidural steroid injection treatment, patients will likely be able to walk around and can resume all regular activities the next day. For most patients, pain relief begins shortly after treatment and may last for several weeks. Because they only provide temporary pain relief, ESIs can be administered in two week intervals in order to provide long-term relief. Patients will usually see Dr. Lipani about a week after treatment in order to evaluate the effectiveness of treatment and determine an appropriate injection schedule for each patient’s individual condition.
Risks of Epidural Steroid Injections
Complications from this procedure are rare but can include infection, headache, bleeding, puncture, allergic reaction or nerve damage. Some patients may experience side effects from the medication, such as hot flashes, mood swings, insomnia, weight gain and more, although these are considered rare as well. Dr. Lipani will discuss these risks with you, as well as address any concerns you may have, prior to administering treatment.