An epidural steroid injection involves the administration of local anesthetic (numbing medication) and steroid solution into the epidural space. This is performed under fluoroscopy (X-ray), in order to deliver the drug to the precise location. There are two types of epidural steroid injections: an intra-laminar approach (more central approach, between the bones of the spine), and a trans-foraminal approach (through the nerve root opening).
Am I a candidate for an epidural steroid injection?
Your Pain Doctor along with your referring physician will determine if you are appropriate for an epidural injection. Usual conditions treated by epidurals include herniated or bulging discs, sciatica, spinal stenosis, degenerative disc disease, neuritis, pain associated with compression fractures.
What are the benefits of an epidural steroid injection?
Epidurals have the ability to reduce inflammation in a localized fashion thereby reducing pain and helping to reset the pain pathways in your body. They have the added benefit of targeting medication release directly to the region or area of pain.
How long does the procedure take?
The entire procedure will take approximately 10 minutes.
Where is the procedure performed?
It is typically done in an office or surgical suite using fluoroscopy.
How is the procedure performed?
Typically an IV is started so that the anesthesiologist can administer sedating medication to make you comfortable. Your doctor will typically identify the area he will be injecting using the X-ray machine, and then provide some local numbing medication (Lidocaine) before placement of the needle. The epidural needle is advanced using x-ray guidance into the epidural space. Needle position is confirmed with the injection of contrast dye (epidurogram), a special technique (loss of resistance), and the X-ray images. The dye will not be used if there is an allergy. Once needle placement is assured, the epidural therapeutic solution is injected.
What if I am afraid of needles?
Typically patients with needle phobia do just fine with sedation to help relax them. They also typically will have little to no memory of the actual procedure.
Is it painful?
Generally no, your doctor will do everything possible to minimize and discomfort during the procedure. This may require sedation and is typically achieved with the numbing medication (lidocaine).
What are the risks and side effects?
The procedure is generally safe. However, with any procedure or medications there are potential risk, complications, and side effects. The potential risks to a certain degree depend on the region of the epidural. Whenever a needle is introduced through the skin there is risk of infection, bleeding, and soreness. For this reason, all our procedures are performed under sterile technique, and a careful history is taken to ensure any risks of bleeding are minimized. On occasion, one may develop numbness do to extensive spread of the local anesthetic. Rarely, an individual can develop a “spinal headache,” this typically occurs 1% of the time. And is more common in younger individuals. Bleeding into the spinal canal on extremely rare occasions can occur. This is referred to as an “epidural hematoma;” this is why it is essential for you to make us aware of any blood thinner medications you are taking; as this can lead to spinal cord and nerve damage. Recently, the FDA issued a black box warning on epidural steroid injections. Please see Informed Consent Documents for further information on this warning. All complications are extremely rare.
What happens if I get a spinal headache?
This headache is typically the result of spinal fluid leaking at the injection site. It is a severe, self limited, headache that gets worse when sitting and standing. It improves with lying down. The headache typically will last for about one week. It is generally well managed with active hydration, caffeine, certain types of medications, and on occasion a procedure called an “epidural blood patch.”
How long does an epidural last for?
A person’s response will vary depending on their underlying condition, severity of illness, and lifestyle. Some people have a single injection. Others have a partial response and may require additional injections to achieve more robust improvement. Some fail to respond completely. You will be re-evaluated following your initial injection by your doctor.