What Does an Epidural Steroid Injection Procedure Really Involve?
Did your doctor recommend that you get an epidural steroid injection and you are not sure what it is? Is it making you nervous?
I received a Pain Letter’s question from one of my patients who states her doctor wants her to get an epidural steroid injection and she would like to know more about that procedure.
First, let’s talk about what an epidural is, and then we'll talk about the procedure itself, and then what you can expect from it.
As the name implies, an epidural steroid injection is a type of injection where steroid is injected into the epidural space around the spinal cord to improve inflammation. We know that inflammation can cause pain and therefore reducing it should reduce pain.
Who is a candidate?
Well, generally it is for people with neck pain or back pain with or without sciatica, who have not been able to achieve relief from more conservative treatment measures, such as nonsteroidal inflammatory or physical therapy. Your physician will order an MRI and typically will find a bulging or herniated disk that is likely causing your pain. It can also be a highly effective treatment for spinal stenosis and pain after failed spinal surgery.
Please see my video about leg pain or spinal stenosis if you want some more information about these conditions.
The technique of an epidural steroid injection involves taking a hypodermic needle and gently placing it into the epidural space with X-ray guidance.
It starts with you lying on your stomach and us cleaning and draping your back. We then take a few X-ray pictures with a fluoroscopy machine. We will then numb the area where we will inject and then we introduce an epidural needle. Once we are in the right spot, we typically confirm the injection with a little bit of dye, unless of course you have an allergy to contrast dye. This is done with minimal tissue damage and thus very little trauma. Most patients experience very minimal pain during this procedure.
There are generally three different types of epidural steroid injections.
So firstly, we have the intralaminar, which is likely the one that you are most familiar with. The placement of this needle is of the same that you would see during labor or pregnancy. The needle is midline and between the vertebrae.
Then number two, there is the caudle epidural steroid injection, where we inject steroids into the lowest part of the spine or into the sacrum, and we will allow it to migrate up the spine and it affects multiple levels.
Finally, there is the transforaminal epidural steroid injection where we inject medication into the epidural space specifically as the nerve root being pinched. So, any of these injections can be extremely effective, and your physician will use their own discretion to advise which one might be best for you.
The question everyone has is how long will it work, and will I need to repeat it?
This is a really difficult question to answer and is very patient specific. We always hope that you will respond maximally after one injection but oftentimes, we will perform up to three injections if you show improvement with each injection. It is important to remember that you may not respond at all.
Finally, what are the side effects of an epidural steroid injection.
This procedure has very few risks. But like any other medical procedure, the potential for risks always exists. The most common risk would be a temporary increase in pain. Rarely, you might have an inadvertent puncture of the spinal sac containing spinal fluid. Other rare complications may include infection, it may include bleeding or even possible nerve injury. Overall though I want to show you that this is an exceedingly safe procedure. If you are a diabetic, you should keep an eye on your sugar as the steroid will make your sugars go up. It is important to note that if you take blood thinners, your physician will give you instructions on how to take your blood thinners prior to your procedure. You should not have this procedure if you are pregnant.
Well, I hope that answers your questions. Please keep those questions coming and I will try my best to answer them.
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