By reducing inflammation, epidural steroid injections (ESIs) are used to temporarily relieve lumbar (lower back), cervical (neck), thoracic (mid-spine) and sciatic-nerve pain. ESIs contain cortisone and an anesthetic, and are delivered directly to the epidural space, which is the area between the spinal cord and the outer membrane that covers the brain and spinal cord (the dura). As a result, they provide more effective and faster pain relief than oral medications.
Candidates for Epidural Steroid Injections
Candidates for epidural steroid injections have back pain, and/or pain radiating down the arms and legs. Pain relieved by ESIs can be the result of many conditions, including the following:
- Lumbar-disc herniation
- Degenerative disc disease
- Lumbar spinal stenosis
- Vertebral compression fractures
- Cysts in a facet joint or nerve root
- Annular tears
Epidural steroid injections can be used alone to provide pain relief, or given as part of a rehabilitation program to help a patient perform physical therapy exercises with less discomfort. Relief from a single injection can last from 1 week up to 1 year; a typical positive response lasts for 1 month. If helpful, injections can be repeated at 2-week intervals, but usually no more than 3 or 4 times per year. ESIs can also be of diagnostic value in pinpointing the source of the pain and determining its severity, which can assist a physician in developing an appropriate treatment plan.
The Epidural-Steroid-Injection Procedure
Epidural steroid injections are administered by many types of physicians, including anesthesiologists, orthopedists, physiatrists, pain-management specialists and neurologists. Typically, they are administered in an outpatient facility, under the guidance of fluoroscopy, to verify that the medication is reaching the inflamed nerve root. Because the injection contains a local anesthetic as well as a corticosteroid, the injection is not usually painful, although a patient may feel pressure at the injection site. The injection procedure takes only a few minutes.
In most cases, the patient experiences immediate pain relief due to the anesthetic, but the relief is temporary and wears off in a few hours. During the next day or two, however, as the corticosteroid works to reduce inflammation, the patient should feel a significant, if not total, alleviation of pain. The patient can usually resume normal activities the day after the procedure.
Risks of Epidural Steroid Injections
Epidural steroid injections are a safe form of treatment, although, in rare instances, they can cause headaches, bleeding, infections, nausea or vomiting, allergic reactions or nerve damage. Patients who are pregnant, have infections, or suffer from chronic bleeding disorders are not candidates for epidural steroid injections. ESIs can temporarily elevate blood pressure and blood sugar, and cause mood swings, so patients with hypertension, diabetes or mood disorders should be monitored before, during and after treatment.
Lumbar Epidural Steroid Injection
A lumbar epidural steroid injection is a minimally invasive procedure for treating leg, buttock and lower back pain originating from the epidural space. The epidural space surrounds the dura, a membrane which protects the spinal cord and its nerves. The primary reasons for pain in this area are herniated or ruptured discs, stenosis, or sciatica all of which result in nerve compression. The pain may originate in any part of the lumbar region of the spine, including the coccyx, or tailbone, where it is referred to as caudal.
A lumbar epidural steroid injection is usually administered in an outpatient surgical setting under local anesthetic. After the local anesthetic has numbed the skin, a small needle is inserted into the epidural space with the assistance of an imaging technique known as fluoroscopy. Once the targeted area is pinpointed, the medications, which include an anesthetic and a corticosteroid, are injected.
After a lumbar epidural steroid injection, most patients return to work the next day. They normally experience immediate pain relief for a few hours after the procedure as a result of the injected anesthetic, although there may be some irritation at the injection site. In a few days, the original pain may worsen again as the anesthetic wears off. This is completely normal. In about a week, the corticosteroids will take full effect, reducing inflammation and significantly reducing pain. Depending on the patient‘s response, the doctor may administer as many as three epidural injections spaced several weeks apart.
The effectiveness of a lumbar epidural steroid injection varies. Some patients experience long-term, or sometimes even permanent, pain relief after one injection, requiring no further treatment. Others may require additional treatment a few weeks or months later. The exact effectiveness of a lumbar caudal epidural steroid injection depends on the individual patient‘s condition.