Epidural Steroid Injections

What are epidural steroid injections?

Epidural steroid injections deliver anti-inflammatory steroids, such as Dexamethasone and Methylprednisolone acetate, directly to the epidural space in the spine, where they treat the inflamed nerve root. Local anesthetics like lidocaine or bupivacaine provide immediate pain relief. Sometimes a saline solution is used to dilute these anesthetics or flush out any inflammatory agents from the epidural area.

How do epidural steroid injections work?

Steroids reduce the swelling and inflammatory response by making the immune system less responsive in the area where there’s nerve or tissue damage. The body responds to injury by sending white blood cells and chemicals to the damaged tissue or nerve root. However, this can increase the pain. By inhibiting the body’s immune response, epidural steroid injections decrease pain and inflammation.

What conditions do they treat?

Epidural steroid injections relieve the pain of an inflamed nerve root, which can be caused by spinal stenosis, spondylolisthesis, vertebral compression fractures, sciatica, herniated lumbar discs, cysts, degenerative discs or annular tears.

Who should avoid epidural steroid injections?

People who are pregnant, who have local or systemic infections, who may have spine tumors, or who have bleeding problems are not candidates for epidural steroid injection. If spinal tumors are suspected, an MRI should be performed.

What happens during an epidural steroid injection?

Epidural Steroid InjectionsThe injection is an out-patient process and typically takes 15-30 minutes. Patients change into a hospital gown and lie down while the injection site is cleaned. A sedative may be administered to patients who are anxious, but the procedure is not painful. Patients are numbed with a local anesthetic prior to the epidural steroid injections.  A fluoroscopy (live X-ray), followed by an injection of contrast dye, ensures the steroid is delivered to the right area.  The patient is observed for 15 to 20 minutes after the injection before being released to return home.

The injection site may be sore for a few days after the procedure. In this case, ice packs applied to the area can ease the pain. Patients may return to normal activities the next day.

Can steroid injections be a permanent fix?

Steroid injections can provide pain relief that is adequate to allow patients to progress in physical therapy. Patients are typically restricted to three injections each year, because more frequent steroid injections might weaken the bones of the spine and nearby muscles. In some cases, that’s enough to facilitate recovery. If, however, the first injections are ineffective, there’s no need to follow up with more injections.

How quickly do injections work?

More than half of patients who received lumbar epidural steroid injections experience pain relief following epidural steroid injections. This relief comes within three to five days, although some experience pain relief sooner. Patients with radicular pain (leg pain) often have the best outcomes. The pain relief typically lasts anywhere from a week to a year.

What are the risks of epidural steroid injections?

Infection, dural puncture, bleeding and nerve damage happen rarely. Headaches, anxiety, trouble sleeping, fever, stomach ulcers, hip arthritis and local pain are reported side effects. Patients experiencing a severe headache, fever over 101 degrees, loss of bladder or bowel control, loss of limbs control or extreme pain, should contact their doctor Immediately.

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