Epidural Steroid Injections
FAQ's on Epidural Steroid Injections
An Epidural Steroid Injection is a very effective, low risk, minimally invasive treatment for lower back pain and leg pain (sciatica). Epidural Steroid Injections have been in use since the early 1950’s to help chronic pain sufferers find relief.
For over 60 years, epidural injections have been a mainstay in pain management because they work well and there are several types available depending on the person's condition.
What conditions are treatable with Epidural Steroid Injections?
The Epidural Steroid Injection is primarily used to treat chronic lower back and leg pain. The procedure is used to treat the symptoms of pain but is not intended as a solution to the cause of the pain (Access routes and reported decision criteria for lumbar epidural drug injections: a systematic literature review 2014).
Often patients with bulging or herniated intervertebral discs experience pain due to impinged (pinched) nerves. When this occurs in the low back, it is termed sciatica. The Epidural Steroid Injection numbs the nerve preventing pain signals to the brain and thus easing the patients suffering.
Spinal stenosis is a condition where nerves are pinched due to degenerative arthritis of the spine. Epidural steroid injections help patients avoid surgery frequently.
Another condition that receives benefit from epidural injections is degenerative disc disease. A torn disc may cause pain in the area, and also lead to a "chemical inflammation" of adjacent nerve roots. For this reason, epidural injections may help considerably with degenerative disc disease exacerbations.
Generally the procedure is performed in conjunction with physical therapy, and in fact may facilitate the patients’ ability to perform the required exercises necessary to help them maintain a certain degree of physical health.
What are expectations when a patient receives an Epidural Steroid Injection?
Patients that undergo Epidural Steroid Injections have a fair expectation of finding at least some level of pain relief depending how well they respond to the medications, some may find complete relief. Often they will experience brief instant relief merely from the local anesthetic used to numb the injection area, but that usually wears off after one day.
Dozens of studies have been performed on epidural injections for sciatica and spinal stenosis. Overall, excellent outcomes occur in 75% of patients undergoing the procedure.
How is the Epidural Steroid Injection performed?
The patient is placed face down on an exam table. Vital signs are monitored and they may be given a sedative to help them relax during the procedure. The area to be injected is cleansed with antiseptic solution. Numbing medicine is injected into the soft tissues going down to the spinal area. With the aid of fluoroscopy (a type of x-ray machine) guidance to ensure proper needle placement the needle is slowly inserted.
Contrast dye is then injected into the treatment area to confirm the correct placement of the needle, then the medications are slowly injected. Often during the injection of the steroid the patient will feel pressure or slight discomfort.
There are actually three different types of epidural injections:
1.Interlaminar epidural injections - this is the "oldest" type of injection, and it works extremely well. The steroid medication is placed in the epidural space just under the bone and soft tissue.
2.Transforaminal epidural steroid injections - these are the "newest" type of epidural. Using image guidance, the steroid is placed in the area where the afffected nerve root is being pinched. This is called the "foramen", hence the name of the injection type.
3.Caudal epidural injections - these involve a larger amount of steroid being placed through the very bottom of the spine. With caudal epidurals, the steroid medication is able to reach multiple nerve roots. So with a condition like spinal stenosis where several nerve roots are being pinched, caudal epidurals are an excellent choice.
After the injection is completed, the patient will be moved to an observation area to watch for negative reaction to the medications. The entire procedure including a 30 minute post procedure observation takes about an hour.
How long do the benefits of Epidural Steroid Injections last?
The duration of the effects of the procedure cannot be anticipated as it is dependent upon how well you respond to the medications used. The effects can last anywhere from just a few weeks, several months, or even a year.
Maximum benefit is usually not achieved from only one treatment however, but may take a few visits, although some patients experience some level of relief from just one visit. A series of 3 injections over 6 to 8 weeks may be necessary for maximal relief, which can be repeated every few months. (Epidural steroids for spinal pain and radiculopathy: a narrative, evidence-based review 2014).
What risk or side effects are associated with Epidural Steroid Injections?
Risks and side effects are very minimal with the procedure. There can be bruising, swelling, or light bleeding in the injection area, but this is nothing to fear. There is a remote chance of infection at the injection site but this is well under 1%. (The risks of epidural and transforaminal steroid injections in the Spine: Commentary and a comprehensive review of the literature 2013).
How successful are Epidural Steroid Injections for the relief of pain?
Better than 75% of patients who receive an Epidural Steroid Injection experience relief from chronic lower back and leg pain, however any one individual’s results cannot be anticipated. Serious side effects occur in less than 1% of patients.
What is the bottom line on Epidural Steroid Injections?
Epidural Steroid Injections can be a very effective treatment for your chronic lower back and/or leg pain. To determine if this procedure could be right for you discuss your symptoms with your Chicago pain management specialist.