Epidural steroid injections (ESIs) are a cornerstone treatment for managing chronic pain, particularly pain stemming from the spine degenerative disc disease causing impingement or inflammation of spinal nerves. These minimally invasive procedures deliver corticosteroids "cortisone" to the epidural space surrounding the spinal cord and nerve roots, reducing inflammation and alleviating pain. When you're suffering from sciatica, herniated discs, or spinal stenosis, an epidural steroid injection might be recommended as part of your pain management plan.
This guide will walk you through every stage of an epidural steroid injection, from consultation to recovery.
Understanding the Purpose of Epidural Steroid Injections
Before diving into the procedure, it’s helpful to understand why Epidural Steroid Injections are performed. Chronic back, neck, or radicular pain (pain radiating from the spine to other areas, like the arms or legs) often originates from inflammation in the spinal nerves.
Conditions commonly treated with Epidural Steroid Injections include:
Herniated or bulging discs: Discs pressing on spinal nerves can lead to significant pain.
Spinal stenosis: Narrowing of the spinal canal causes nerve compression.
Sciatica: Compression or irritation of the sciatic nerve leads to radiating pain in the legs.
Spondylolisthesis: Misaligned vertebrae that cause nerve irritation.
Degenerative disc disease: Worn discs may inflame nearby nerves.
Corticosteroids injected into the epidural space work by reducing inflammation, relieving nerve irritation, and ultimately decreasing pain. While Epidural Steroid Injections don’t cure the underlying condition, they offer symptomatic relief that may facilitate physical therapy or other treatments.
Who Performs Epidural Steroid Injection?
A physician will perform the Epidural Steroid Injection
Typical specialists include Anesthesiologist, Physiatrists, Interventional Radiologists, and sometimes Neurosurgeons with advanced training in Pain Management.
It is recommended you have your ESI performed by someone who is fellowship-trained and is Board Certified in Pain Management
Different Types of Epidural Steroid Injections.
There are different approaches to accessing the epidural space around your spinal cord in your low back, those include:
Interlaminar ESI: With this method, the path of the needle is in between two laminae in your spine to get to the epidural space. A lamina is the flat plate of bone that’s part of each vertebra in your spine. The laminae in your spine form the outer wall of the spinal canal and protect your spinal cord. Providers commonly use interlaminar lumbar ESIs to provide temporary pain relief for disk herniation, spinal stenosis with or without radicular pain and localized (axial) low back pain.
Transforaminal ESI (TFESI): With this method, the path of the needle is through the foramina, which are openings through which nerve roots exit your spine. Providers commonly use transforaminal lumbar ESIs to provide temporary pain relief for radicular pain caused by disk herniation or a specific injury to an individual nerve root.
Caudal ESI: With this method, the path of the needle is through the sacral hiatus, which is towards the bottom of your sacrum and just above your tailbone, to reach the lowest spinal nerves. Your sacrum is the triangular bone in your low back that’s situated between your hip bones. Providers may use a caudal lumbar ESI to provide temporary pain relief for “failed back” syndrome. Caudal ESIs generally have fewer risks than interlaminar and transforaminal ESIs.
Pre-Procedural Preparation
If an ESI is recommended, your doctor will provide detailed pre-procedure instructions. Key steps may include:
Medication Adjustments:
Blood-thinning medications may need to be paused several days before the injection to reduce bleeding risks.
You may need to inform your doctor about any other medications or supplements you're taking.
Arranging Transportation:
Since you might feel drowsy or uncomfortable post-procedure, it’s important to arrange for someone to drive you home.
Clothing and Comfort:
Wear loose, comfortable clothing to ensure easy access to the injection site.
Addressing Concerns:
Use this time to ask any lingering questions or share any anxieties you may have.
During the Procedure: Epidural Steroid Injection Step-by-Step Guide
Epidural steroid injections are usually performed on an outpatient basis and take about 20–30 minutes, though the exact duration may vary. Here's what typically happens:
1. Checking In
Upon arriving at the clinic, you’ll check in and confirm your medical information. A nurse or assistant will guide you to the procedure room where you will have a chance to ask questions about the procedure and you will sign a consent form outlining potential risks..
2. Positioning and Preparation
Once in the procedure room:
You’ll be positioned lying on your stomach.
The target area of your back or neck will be cleaned thoroughly with an antiseptic solution to minimize infection risk.
Local anesthetic will be applied to numb the skin and deeper tissues at the injection site. You may feel a brief pinch or sting.
3. Imaging Guidance
To ensure precision, your doctor will use fluoroscopy (real-time X-ray) throughout the Epidural Steroid Injection. This helps locate the exact area for the injection, ensuring the medication reaches the inflamed nerves.
4. Inserting the Needle
Once the target is identified:
A thin, hollow needle is inserted into the epidural space. You will feel pressure or slight discomfort, but this should not be painful.
Contrast dye is injected to confirm the needle's placement on the imaging screen.
5. Delivering the Medication
Once the needle is correctly positioned:
The corticosteroid solution, often combined with a local anesthetic, is injected.
Some patients report a sensation of warmth or mild pressure during this step. It is normal to feel a sensation of pressure down one or both legs or arms, depending on where the injection is being performed.
6. Finishing Up
After the injection:
The needle is removed, and a small bandage is applied to the site.
You’ll be moved to a recovery area for observation.
After the Procedure: Recovery and Results
Immediate Recovery
You’ll stay in the clinic for 10-20 minutes after the procedure. During this time:
A nurse will monitor your vital signs and ensure you feel well before leaving.
You might experience temporary numbness, tingling, or soreness near the injection site.
You might feel numbness of weakness in your legs following a lumbar ESI, this is always temporary and is a potential effect of the local anesthetic on the nerves.
Activity Restrictions
Rest is encouraged for the first day, but you can typically resume normal activities the following day.
Avoid strenuous activities, heavy lifting, or intense exercise for at least 24–48 hours.
Symptom Relief Timeline
Relief may not be immediate. While some patients feel improvement within hours, it often takes a few days up to 2 weeks for the steroids to reduce inflammation and alleviate pain.
Pain relief can last from several weeks to months, depending on the condition and individual response.
Potential Side Effects and Risks
ESIs are generally safe, but like any medical procedure, they carry some risks. Potential side effects include:
Common, mild effects:
Temporary soreness at the injection site. Using an ice pack to the area for 20 minutes every one hour can help with soreness.
Temporary weakness or numbness.
Mild headaches or dizziness.
Facial flushing or a feeling of warmth (less common)
Insomnia for 1-3 days after injection (less common)
Rare but serious risks:
Infection at the injection site.
Bleeding or nerve damage.
Spinal headaches caused by accidental puncture of the dura (a protective membrane around the spinal cord).
Allergic reaction to the contrast dye or medication.
Your doctor will take every precaution to minimize these risks and ensure your safety.
When to Call Your Doctor
While complications are rare, contact your doctor immediately if you experience:
Severe or worsening pain.
Signs of infection (fever, increasing pain, redness, or swelling at injection site).
Loss of bladder or bowel control.
Numbness or weakness in your arms or legs that lasts for more than two hours
Frequently Asked Questions
1. Will the Epidural Steroid Injection hurt?
Most patients report minimal discomfort, thanks to the local anesthetic and careful technique used by the doctor. Any pressure or stinging is typically brief. Usually the local anesthetic injection is the most uncomfortable part of the procedure.
2. How many injections will I need?
This depends on your condition and response to treatment. Some patients achieve sufficient relief after one injection, while others may require a series of 2–3 injections spaced weeks apart.
3. Can I drive myself home?
No. Because you may experience mild side effects, arranging for someone to drive you home is recommended.
4. Are Epidural Steroid Injections a permanent solution?
Epidural Steroid Injections provide temporary relief but do not address the underlying cause of pain. They are often used in conjunction with other treatments, such as physical therapy or lifestyle modifications.
Conclusion
Epidural steroid injections can be a valuable tool in the management of chronic spine-related pain. They provide targeted relief, allowing patients to engage in physical therapy, resume daily activities, and improve their quality of life. By understanding what to expect during the procedure, you can approach your ESI with confidence and focus on your path to recovery.
If you’re considering an epidural steroid injection or want to learn more about interventional pain management, schedule a consultation with our clinic today. Our team of specialists is dedicated to providing personalized, compassionate care to help you regain control of your life. At our pain management clinics in Sacramento and Vacaville we specialize in providing compassionate and expert care through interventional pain management techniques, including epidural steroid injections.
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