Ask the Doctors: What is an Epidural Steroid Injection?

What is an Epidural Steroid Injection?

The term epidural steroid injection refers to the injection of corticosteroids, (powerful anti-inflammatory medication) into the epidural space (around the spinal nerves) as  a means of treating pain caused by irritation   The spinal cord runs within the bony canal of the vertebral column and is encased by a membranous sac called the dura.   This sac contains spinal fluid, which bathes and nourishes the spinal cord.  The epidural space is the space between the outer surface of the dural sac and the inner surface of the vertebral column.  Cortisone is a type of steroid that is produced naturally by a gland in your body called the adrenal gland.  Cortisone is released from the adrenal gland when your body is under stress.  Natural cortisone is released into the blood stream and is relatively short-acting.   Injectable cortisone is synthetically produced and has many different trade names (Celestone, Kenalog, etc.)  but is a close derivative of your body’s own product.  The most significant differences are that synthetic cortisone is not injected into the blood stream, but into a particular area of inflammation.  Also, the synthetic cortisone is designed to act more potently and for a longer period of time (days instead of minutes).

Why Choose an Epidural Steroid Injection?

To manage certain types of back and neck pain that may radiate into the arms or legs. It is referred to a radicular or nerve pain. The common term for nerve pain to the legs is sciatica.   An epidural steroid injection is usually recommended and performed after conservative treatment consisting of physical therapy, chiropractic treatment, analgesics, and/or muscle relaxants, have failed to improve a patient’s symptoms.  In some instances epidural steroid injections may be indicated earlier in treatment secondary to medical contraindications to certain oral analgesics or in cases where a patient pain severity substantially limits their ability to engage in therapeutic exercise.  Epidural steroid injections may also be done prior to surgery, (as some patients choose to have surgery as there last option).

How are Epidural Steroid Injections Performed?

Epidural steroid injections can be given by various physicians, including physiatrists, interventional pain management specialists, anesthesiologists, orthopedic surgeons, neurologists, if they have been trained in this procedure.  There are several different approaches in which a steroid injection can be administered (interlaminal and/or transforaminal). The approach is decided based on the patient’s symptoms and pathology.

At Long Island Spine Specialists, the physicians Dr. Sanelli and Dr. Abbasi have been trained with the highest level of medical expertise.  They perform epidural steroid injections under fluoroscopic guidance (special x-ray) to ensure that the needle is in the appropriate position.) The procedure is performed at the North Shore Surgical Center, or in the ambulatory surgery center at affiliated hospitals.   At the start of the procedure, the patient is positioned onto an x-ray table so that the vertebrae of the back are as widely spaced as possible. A local anesthetic is injected into the skin and the underlying tissues to decrease the discomfort of introducing the epidural needle.  Once the local anesthetic is working, the epidural needle is advanced into the epidural space, using the bones as landmarks under fluoroscopy, again to guide the needle to the correct location.  Having a needle injected into your spine without the use of a fluoroscope decreases the chances of accurate needle placement and increases the potential for serious side effect.  This is your spinal canal. The fluoroscope verifies placement. Once the needle is in the epidural space, a syringe containing the corticosteroid solution is connected to the needle.  After making sure that the needle is not in a blood vessel or in the spinal fluid, the physician slowly injects the solution.   The corticosteroid will be injected in a form that may include a saline solution and/or a local anesthetic; however, the dosage of steroid may vary according to the physician’s judgement.  The needle is removed and a band-aid is applied.  Approximately thirty minutes later the patient is on there way home unless the patient had intravenous sedation, in which case it may be a little longer.

Risks:

When performed by a skilled, experienced clinician in an appropriate setting and with carefully selected patients, the chance of significant complication from the epidural steroid injection is remote.  Nonetheless, similar to regional analgesia procedures, there are associated risks with epidural steroid injections.  The more common risks from lumbar epidural steroid injections are as follows: backache, postural headache (1%), vasovagal reaction (fainting), and increase in pain (1 %).   There is also the possibility of an allergic reaction to one of the medications used.  You may experience a hot flush or develop a rash, which will resolve in a few days.   As with any injection through the skin, it is possible for bacteria to gain entry causing an infection.   The physicians at LISS choose to do these procedures in a completely staffed Surgi-Center or ambulatory hospital setting to ensure patient safety. There is an Anesthesia Department available as well, if the patient desires some form of sedation.  There are other physicians in the community who also hold to this level of excellence. 

The Benefits:

Pain relief is the benefit.  A patient may have up to three injections to obtain optimal results in a six-month-period. The amount, the frequency, and the level of results vary patient to patient. Eighty percent of patients do obtain relief.  If no relief is obtained, there are other courses of pain management that may be taken or a surgical consultation may be indicated.

The success of spine pain intervention for relief of pain depends on the standards, methods, and team used in treatment. When seeking a physician choose one who is Board-certified and whose practice holds to the highest standard of excellence.