What is an epidural steroid injection and what does it do?
This is a procedure during which your doctor will use a needle to inject steroid and numbing medication into the epidural space in your back. Steroids are strong anti-inflammatory medications. The epidural space is the space surrounding your spinal cord and nerve roots in your back. Inflammation in and around this space can irritate sensitive structures in this area causing back and leg pain. This can also cause numbness, tingling or burning sensations in the legs.
Injecting steroids into the epidural space can decrease inflammation and decrease or eliminate pain and other symptoms caused by this. Different types of steroids may be used depending on the level of your injection and your doctor’s preference.
Why are epidural steroid injections performed?
Your doctor may recommend an epidural steroid injection for treatment of back or leg pain or both. Epidural steroid injections are most commonly performed for treatment of back and/or leg pain caused by disc herniation or spinal stenosis.
Knowing your back:
Vertebrae: These are the bones in your back and neck that stack up in a column from your tailbone up to your head, forming your spine.
Spinal canal: This is the space in the middle of your spine where your spinal cord and nerves are found. One set of nerves exits out either side of the canal at each level of the spine. The openings through which these nerves exit are called foramen.
Discs: These are cushion like structures found in the front of the spine in between each vertebra. Discs can herniate into the spinal canal causing inflammation and pain.
Facet joints: These are small joints found in the back of the spine that connect two levels of the spine. Each level of the spine has two facet joints, one on each side. These joints can develop arthritis just like a hip or a knee and this can become a source of pain.
Spinal cord: This is the structure that connects your brain to individual nerve roots so that signals can be sent from the brain out to the rest of the body or from the body back to the brain.
Nerve roots: These are the individual nerves that exit at each level of the spine. Nerves in the neck travel down into the arms and nerves in the back travel down into the legs. This is why irritation or compression of these nerves can cause symptoms in the arms or legs.
What should I do to prepare for the procedure:
Make sure you are aware of any medications that need to be held and for how long. This is determined on an individual basis. Make sure that your doctor and their staff is aware of any blood thinners that you are taking. This includes medications like Warfarin, Plavix, Aspirin, Eliquis and others. Anti-inflammatory medications such as Ibuprofen and Aleve can have some blood thinning effects as well and your doctor may ask that you hold these medications as well.
Your procedure may have been scheduled to be performed with IV sedation. Make sure you know if this is the case or not. If it is you will be required not to eat or drink anything for several hours prior to the procedure and you will be required to have someone to drive you home after the procedure and stay with you to make sure that you are safe.
Please be prepared to answer questions regarding your medical history and current medications from the nursing staff on the day of your procedure. This means knowing or having a list of your medical problems, any medications that your are currently taking and any allergies that you have to medications or contrast dye.
What to expect before the procedure:
Make sure you know when to arrive. You will be asked to arrive prior to your actual procedure time in order to allow time to check you in and prepare you for the procedure. You will change and an IV will be placed in a pre-op area where your doctor will meet you and explain the procedure before taking you back to the actual procedure room.
What to expect during the procedure:
You will be connected to equipment to monitor your blood pressure, heart rate and oxygen level during the procedure. You will be lying on a narrow table with an x-ray machine over it that will allow your doctor to take pictures in order to guide needle placement during the procedure. The skin and superficial tissues will be numbed locally in the area where the injection will be performed and then the needle will slowly be guided down into the epidural space where the medication will be injected.
What to expect after the procedure:
Afterwards you will be taken to a recovery area where you will be monitored for a short time before being sent home. You should refrain from strenuous activity for the remainder of the day but it is not necessary to rest in bed. Showering is OK but you should refrain from swimming or sitting in any tubs. The following day you can resume your normal activities.
The numbing medicine injected during the procedure will work right away but will wear off after a few hours. The steroid generally takes a few days and sometimes up to two weeks to start working well. Sometimes there is a period of increased pain for a few days after a steroid injection. This is not worrisome or dangerous, but if you are concerned or have questions you can always contact your doctor.
You will be provided with a pain diary to keep track of your average daily pain scores for the next 2 weeks following your injection. Please fill out this diary and bring it with you to your follow-up appointment, as it will provide your doctor with useful information.
What are the risks of this procedure:
Your doctor will provide you with a detailed consent form on the day of the procedure but risks include bleeding, infection, spinal headache or nerve injury. These complications are very rare. Your doctor will do everything that they can to reduce the risk of these complications during the procedure.
Side effects from steroid injections can include temporarily increased pain, headache, facial flushing, trouble sleeping, mood changes and increased blood pressure/blood sugar. These side effects are temporary and generally subside after 5-6 days. Most people do not have these side effects.
Please call your doctor if you experience any of the following after your injection:
- Redness or swelling at the injection site
- Fever of 101.4 F (38.5 C) or higher
- New or worsening weakness or numbness in the legs
- Loss of control over your bowel or bladder
- Severe pain or headache