Epidural Steroid Injection

Posted by Abbie on Dec 16, 2003 in Treatments |

Overview

Epidural injection is the administration of medication into the epidural space. It is used to treat swelling, pain, and inflammation associated with neurological conditions that affect nerve roots, such as a herniated disk and radiculopathy.

Epidural injections may be painful and produce uncertain results. Studies show that epidural injection may provide short-term pain relief for patients when conservative treatments have failed.

Anatomy

The brain is covered by three membranes (dura, arachnoid, and pia), called the meninges that extend through the base of the skull and surround the entire spinal cord. The spinal cord travels down the entire length of the spinal column through the spinal canal. The epidural space is located between the dura and the interior surface of the spinal canal and contains veins, arteries, and fat. Epidural injection is the injection of medication into the epidural space.

Procedure

Epidural injection is usually given in an outpatient setting. An anesthesiologist usually administers the injection, but some neurosurgeons, orthopedic surgeons, and neurologists are also qualified to perform this procedure.

A mild sedative and a local anesthetic may be given prior to the procedure to relax the patient and numb the injection site. Medications, usually an anesthetic such as bupivacaine (Marcaine?) or a muscle relaxant, and a corticosteroid such as methylprednisolone (Medrol?), are injected directly into the epidural space. (The injection is commonly called a cortisone shot.)

Effectiveness

Approximately 30% to 70% of people who receive an epidural injection benefit from it. Some patients notice improvement within hours of the injection; others improve over a number of days; and others experience no improvement with the treatment. In some cases, two or three injections are given over weeks or months.

Complications

Complications resulting from an epidural injection are rare. Possible conditions that may develop following the procedure include infection (e.g., epidural abscess), bleeding into the epidural space, and headache caused by a cerebrospinal fluid leak. Approximately 2% of patients experience side effects from the corticosteroid, such as mild fluid retention.

Lumbar Epidural Steroid Injection:

Your physician may refer you for a procedure called an Lumbar Epidural Steroid Injection. This procedure is used to treat swollen and inflamed spinal nerve roots often referred to as a “pinched nerve.” The spinal nerves come from the spinal cord and exit the backbone to provide sensation to different parts of the body. Occasionally something rubs or irritates these nerves where they exit the backbone causing them to be swollen and inflamed. The source of irritation may be a ruptured, herniated, or bulging disc. Another source may be Spinal Stenosis, where arthritis of the spine, bone growth, or hardening of the ligaments begins to close the openings in the spine through which these nerves exit. Common problems associated with this inflammation of the spinal nerves include:

Pain in the lower back
Pain down one or both legs
Numbness or tingling of your legs or feet
Weakness in one or both legs or feet

Your symptoms may include some or all of the above problems. Your physician may treat these symptoms with oral medications and/or physical therapy or exercise. Another method for treating this condition is called an EPIDURAL STEROID INJECTION. This technique involves an injection of a steroid into an area of your lower back called the epidural space. The epidural space extends through the spinal canal from your head to your tailbone. The spinal nerves pass through the epidural space and are therefore bathed in this steroid (a solution of anti-inflammatory medicine). After the procedure you will be asked to reduce your activities at home for 24 to 48 hours to allow the medicine a chance to do its work. Within a few days after the injection, the medicine should reduce the swelling and inflammation of these nerves and thereby reduce your symptoms.

You will probably be asked to return two weeks after your first injection. If all of your pain or numbness has been relieved, you will not need another shot at that time. Most often, however, the first injection will relieve most, but not all of your pain or numbness. At that time (2 weeks after the first injection) we will suggest a second EPIDURAL STEROID INJECTION. Occasionally you may require a third injection two weeks after the second one. After a series of three injections, you should probably wait six months before starting another series of injections.

EPIDURAL STEROID INJECTIONS work very well for most people with the above problems. While it will not cure everyone, this procedure can be extremely helpful to relieve the pains caused by “pinched nerves”.
If you have questions about this procedure, please discuss them with your anesthesiologist.

Here are some commonly asked questions and answers:

Will this injection cure my problem?

Although this procedure may give excellent pain relief, it will not fix the source of the “pinched nerve”. However, by reducing the inflammation of the nerve and with the help of some exercises provided by your orthopedist or physical therapist, you should have months to years of freedom from pain. And although you may have to return for a repeat series of Epidural Steroid Injections in future years, many people prefer this treatment than having surgery to repair the defect.
Are you going to give me a shot in my back!?!

Yes. This is the best and easiest approach to the Epidural Space. We do not inject anything directly into the spinal nerves or spinal cord. As stated above, by using the Epidural Space the medicine can soak into the nerves very easily without a direct injection into the nerve itself.
I only have pain in my leg. Why are you giving me a shot in the back?

As stated, the nerves which supply feeling to your legs come from the spinal cord in your lower back. The site of irritation of this nerve is usually in the lower back where the nerve leaves the spinal canal or backbone. Your Doctor referred you for this treatment because he feels this may be the source of your problem.
Is this procedure safe? What are the risks?

As with any procedure, there are always certain risks involved with injections. Epidural Steroids have proven to work very well and carry very low risks of injury. However, anytime you receive a shot there is a minimal risk of complications. It is rare that these complications ever cause a significant problem. The following are some, but not all of the possible complications:
1. Bleeding or Infection at the site of the injection: Minimal bleeding is not uncommon, but it is extremely rare that this is a significant problem
2. Pain during or after injection: This is not a common problem, but may occur when there is significant swelling and irritation of the nerve root prior to the injection. This is usually self limiting (it doesn’t last long) and does not usually occur with the second or third injection.
3. Post-spinal Headache: Occasionally the needle enters the dura (the membrane that covers the spinal fluid and nerves). This is called a “wet tap”. This does not occur very often, but when it does, the patient gets a particular type of headache. As stated, this is an uncommon occurrence and there is a treatment for this type of headache when it occurs.
4. Reaction to medications or nerve injury: Reactions to the medications can occur but are quite unusual. Injuries to nerves or nerve roots are possible, but extremely rare.
Will these steroids cause my muscles to increase like the athletes that take illegal steroids?

No. These steroids are anti-inflammatory agents, not the anabolic steroids like athletes use.

Cervical Epidural Steroid Injections:

Your physician may refer you for a procedure called a Cervical Epidural Steroid Injection. This procedure is used to treat swollen and inflamed spinal nerve roots often referred to as a “pinched nerve.” The spinal nerves come from the spinal cord and exit the backbone to provide sensation to different parts of the body. Occasionally something rubs or irritates these nerves where they exit the backbone causing them to be swollen and inflamed. The source of irritation may be a ruptured, herniated, or bulging disc. Another source may be Spinal Stenosis, where arthritis of the spine, bone growth, or hardening of the ligaments begins to close the openings in the spine through which these nerves exit. Common problems associated with this inflammation of the spinal nerves in the neck or cervical spine include:

Pain in the neck or shoulders
Pain down one or both arms
Numbness or tingling of your shoulders, arms, or hands
Weakness in one or both shoulders, arms, or hands

Your symptoms may include some or all of the above problems. Your physician may treat these symptoms with oral medications and/or physical therapy or exercise. Another method for treating this condition is called an EPIDURAL STEROID INJECTION. This technique involves an injection of a steroid into an area in the back of your neck called the epidural space. The epidural space extends through the spinal canal from your head to your tailbone. The spinal nerves pass through the epidural space and are therefore bathed in this steroid (a solution of anti-inflammatory medicine). After the procedure you will be asked to reduce your activities at home for 24 to 48 hours to allow the medicine a chance to do its work. Within a few days after the injection, the medicine should reduce the swelling and inflammation of these nerves and thereby reduce your symptoms.

You will probably be asked to return two weeks after your first injection. If all of your pain or numbness has been relieved, you will not need another shot at that time. Most often, however, the first injection will relieve most, but not all of your pain or numbness. At that time (2 weeks after the first injection) your anesthesiologist may suggest a second EPIDURAL STEROID INJECTION. Occasionally you may require a third injection two weeks after the second one. After a series of three injections, you should probably wait six months before starting another series of injections.

Here are some commonly asked questions and answers:

Will this injection cure my problem?

Although this procedure may give excellent pain relief, it will not fix the source of the “pinched nerve”. However, by reducing the inflammation of the nerve and with the help of some exercises provided by your orthopedist or physical therapist, you should have months to years of freedom from pain. And although you may have to return for a repeat series of Epidural Steroid Injections in future years, many people prefer this treatment than having surgery to repair the defect.
Are you going to give me a shot in the back of my neck?

Yes. As noted above, in this instance the nerves involved are located in the cervical spine. This is the best and easiest approach to the Cervical Epidural Space. We do not inject anything directly into the spinal nerves or spinal cord. By using the Epidural Space, the medicine can soak into the nerves very easily without a direct injection into the nerve itself.
I only have pain in my arm. Why are you giving me a shot in the neck?

As stated, the nerves which supply feeling to your arms and hands come from the spinal cord in your neck (the cervical spine). The site of irritation of this nerve is usually in the cervical spine where the nerve leaves the spinal canal or backbone. Your Doctor referred you to us because he feels this may be the source of your problem.
Is this procedure safe? What are the risks?
As with any procedure, there are always certain risks involved with injections. Epidural Steroids have proven to work very well and carry very low risks of injury. However, anytime you receive a shot there is a minimal risk of complications. It is rare that these complications ever cause a significant problem. The following are some, but not all of the possible complications:
1. Bleeding or Infection at the site of the injection: Minimal bleeding is not uncommon, but it is extremely rare that this is a significant problem
2. Pain during or after injection: This is not a common problem, but may occur when there is significant swelling and irritation of the nerve root prior to the injection. This is usually self-limiting (it doesn’t last long) and does not usually occur with the second or third injection.
3. Post-spinal Headache: Occasionally, the needle enters the dura (the membrane that covers the spinal fluid and nerves). This is called a “wet tap”. This does not occur very often, but when it does, the patient gets a particular type of headache. As stated, this is an uncommon occurrence and there is a treatment for this type of headache when it occurs.
4. Reaction to medications or nerve injury: Reactions to the medications can occur but are quite unusual. Injuries to nerves or nerve roots are possible, but extremely rare.
Will these steroids cause my muscles to increase like the athletes that take illegal steroids?

No. These steroids are anti-inflammatory agents, not the anabolic steroids like athletes use.