Steroid Injections

Steroid Injections

What are Steroid Injections?

Healthcare providers often suggest epidural steroid injections (ESIs) to assist in managing chronic pain. This technique involves injecting an anti-inflammatory medication into the area around your spinal nerves in the epidural space, depending on the origin of your discomfort. Approximately half of the people who undergo ESIs experience temporary relief from their pain.

What is an epidural steroid injection (ESI)?

Epidural Steroid Injection (ESI) is an injection of corticosteroid into the epidural space around the spinal nerves to manage pain caused by the inflammation of spinal nerves. This chronic pain management method helps relieve discomfort in the neck, arms, back and legs due to a few conditions or injuries. Its effect is long-term, sometimes lasting several days or months.

  • ESI Injections are often referred to as 
  • Spinal Injections for Back Pain, 
  • Back Pain Injections, 
  • Steroid Injection – Epidural or 
  • Steroid Injection – Back. 

However, it should be noted that they are distinct from the Epidural Anesthesia or Analgesia used during labor or surgery which involves an injection of a local anesthetic medication into the epidural space, numbing certain body regions.

How does an epidural steroid injection work?

An epidural steroid injection (ESI) is a common pain management technique used for long-term relief. During this procedure, a steroid or corticosteroid medication is injected into the space surrounding your spinal cord, known as the epidural space.
Your spinal cord is an essential bundle of nerves running from your brain to your lower back, forming a type of neural highway. It connects the nerves in your body to your brain, allowing it to transmit signals and messages to the rest of your body.
The epidural space is made up of fat, the dural sac, spinal nerves, blood vessels, and connective tissue, and it is situated around your spinal cord like a sleeve. The bones of your spine are composed of a series of vertebrae, which form a column that helps to protect the spinal cord from injury. Additionally, there are disks between the vertebrae that offer cushioning and flexibility.


Occasionally, the nerve roots attached to your spinal cord can become pinched or inflamed, resulting in pain that may radiate down your arm, buttocks, or legs, depending on the exact location of the inflammation along your spine.
In this situation, an epidural steroid injection will provide relief by coating the irritated nerves and reducing the swelling and pressure. The steroid gives the nerve time to heal, leading to temporary pain relief, although long-term or permanent relief is also possible. ESIs may also be used to identify the painful nerve.

Healthcare professionals utilize epidural steroid injections to address chronic ache induced by irritation of spinal nerve roots. Common symptoms of this type of nerve distress are backache that extends to the buttocks and/or legs and cervical discomfort radiating to the arms.

Epidural steroid injections can provide alleviation of pain caused by the following conditions:

  • herniated/bulging discs that pinch nerves;
  • spinal stenosis, which is the narrowing of one or more of the spine’s spaces;
  • unsuccessful results with spine or back surgery referred to as failed back surgery syndrome;
  • osteophytes or vertebral bone spurs;
  • nerve root distress caused by scoliosis;
  • degeneration of the spine (spondylolysis)
  • and other injuries to the spinal nerves, vertebrae and nearby tissues.

These injections are just one of many strategies healthcare providers may use to mitigate pain related to particular sources. Your provider may only advise an ESI if the pain does not show any improvement with physical therapy, medicine or other nonsurgical approaches.

Epidural Steroid Injections (ESIs) are categorized according to their positioning along the spine: cervical, thoracic or lumbar, as well as the pathway the needle follows to reach the epidural space: interlaminar, transforaminal or caudal.

These types of ESIs are dependent on which portion of the spine your healthcare provider injects the medication:

Cervical (neck) ESI: Needle insertion is directed to the side of the neck (cervical region) in the case of cervical ESIs. These can be prescribed by a medical practitioner to treat pain in the neck that spreads to the arms, due to a herniated disk, bone spur or stenosis.

Thoracic (upper and middle back) ESI: For this kind of ESI, the needle enters from the side of the upper or middle back, also known as the thoracic region. If the cause of upper or middle back pain is a thoracic disk herniation or thoracic spinal stenosis, your doctor may recommend this type of injection.

Lumbar (low back) ESI: A lumbar ESI requires the needle to be inserted slightly into the side of the spine in the lumbar region. Such injections can help ease lower back and leg pain from lumbar herniated disk, lumbar degenerative disk disease or lumbar spinal stenosis.

 

In order to access the epidural space around the spinal nerves, there are various methods available. Three of these types of epidural steroid injections, each taking a unique path to the epidural space which are Interlaminar (between the lamina), Transforaminal (across the foramen) and Caudal (via the sacrum). 

Interlaminar involves the needle passing between two laminae of the spine. A lamina is a flat bone plate found in every vertebra and form the external wall of the spinal canal. 

Transforaminal means that the needle goes through the foramina, which are passageways through which the nerve roots pass. 

Lastly, Caudal takes the needle through the sacral hiatus near the bottom of the sacrum and just above the tailbone. The sacrum is the triangular bone in the lower back between the hip bones.

Every year, health practitioners administer almost nine million epidural steroid injections in the United States to assist individuals who suffer from long-term pain.

 

Who performs an ESI injection?

Those who administer epidural steroid injections must possess considerable specialized knowledge in the process. Healthcare practitioners authorized to carry out ESIs comprise

  • physiatrists (physicians specializing in physical medicine and rehabilitation), 
  • radiologists, 
  • anesthesiologists, 
  • neurologists, 
  • and surgeons.

It is essential to inform your healthcare provider if you are pregnant or may be pregnant prior to having an epidural steroid injection (ESI). Additionally, disclose the medicines you are taking, including natural supplements, herbs and over-the-counter drugs.

Your healthcare professional will give you specific instructions to prepare for the ESI injection. It is important to follow their instructions precisely. They may ask you to refrain from eating or drinking for a certain time period, alter your current medications particularly those that act as blood thinners, do an MRI or CT scan of your back prior to the injection to help identify the affected area, and make sure someone can drive you home if you plan on taking a sedative for the injection.

When meeting with your healthcare provider prior to your ESI injection, it may be useful to ask them the following questions:

How experienced are you in administering ESI injections?

What do I need to do to ready myself for my ESI injection?

What potential risks are associated with an ESI injection?

What sensations can I expect to feel during my ESI injection?

How long will the effects of the ESI injection last?

Your epidural steroid injection will most likely take place at a hospital or an outpatient clinic.

 

Your healthcare professional will inject the epidural somewhere along your spine, depending on what is causing your pain. The general steps of an epidural steroid injection process are as follows:

To reduce the danger of infection, your healthcare practitioner will thoroughly clean the area of your back where the epidural will be inserted.

With a little needle, your provider will inject local anesthesia around the location where the epidural will be inserted. This is done to reduce your agony when the epidural needle, which is larger than a regular shot needle, is inserted. They may also administer sedatives to help you relax.

Once the area has been numbed, your provider may utilize an imaging machine, such as a fluoroscopy or X-ray, to help guide the epidural needle to the proper place. It is critical to remain completely still during this operation.

Your provider may inject contrast material while the epidural needle is in the epidural area surrounding your spinal cord. The contrast material will help your provider see the area they’re aiming for on the imaging machine’s screen. This ensures that the drug reaches the irritated nerves that are being treated.

The medication, which is commonly an anti-inflammatory medication such as a steroid or corticosteroid, will then be slowly injected by your provider. Some physicians may administer a corticosteroid and a local anesthetic combination.

After the injection, your provider will apply pressure to the site to prevent bleeding, clean the area again, and put a bandage to the site. You’ll sit or lie down for a few minutes to an hour to rest. This is so your provider can ensure you have no adverse reactions to the drug before you leave.

As your physician injects the local anesthetic to numb the area before your ESI injection, you should feel a small squeeze.

You may experience none of the following sensations during the ESI injection:

  • Pressure.
  • Tingling.
  • There is a burning sensation.
  • Temporary discomfort.
    If you experience any discomfort during the injection, it should subside as the injection is completed.

Inform your provider right away if you have strong, sharp pain during or after your ESI injection.

 

You may have some discomfort where your healthcare practitioner inserted the needle after your injection. This is common and should last only a few hours.

 

Your provider may advise you to relax and limit your activity for the rest of the day.

 

Your discomfort may worsen for two to three days following your ESI before it starts to improve. Epidural steroid injections begin to work within two to seven days and provide pain relief for many days or longer.

The following is a list of side effects:

 

Before the steroid drug begins to act, you may notice a short increase in pain.

Tenderness and/or bruising may occur at the injection site.

If your clinician employs fluoroscopy for imaging guidance, the X-rays will expose you to very little low-level radiation. Unborn newborns may be harmed by fluoroscopy x-rays. Before undergoing the treatment, you must inform your healthcare professional if you are pregnant or suspect you are pregnant.

If you have diabetes, an epidural steroid injection will almost certainly result in elevated blood sugar (hyperglycemia). This could last for several hours or days.

An ESI may briefly raise your blood pressure and ocular pressure if you have glaucoma.

The advantages of epidural steroid injections include:

 

You will most likely feel temporary pain relief. Some people benefit from long-term pain alleviation.

You’ll probably have a higher quality of life and an enhanced capacity to accomplish daily tasks without the limitations that pain previously imposed.

Epidural steroid injections may help you determine the source of your pain. This is frequently useful in patients who have more than one plausible source of discomfort.

Epidural steroid injections may lessen the need for more invasive pain treatment methods.

Although epidural steroid injections are generally safe, various side effects and difficulties can occur. Although uncommon, the following risks and problems are associated with ESI injections:

 

Possessing low blood pressure, which can cause dizziness.

A significant headache is being produced by spinal fluid leaks. This is a rare side effect that affects less than 1% of the population.

Infections caused by the epidural technique, such as epidural abscess, discitis, osteomyelitis, or meningitis.

Experiencing an adverse reaction to the drugs, such as hot flushes or a rash.

Experiencing bleeding if a blood artery is mistakenly injured during the injection, which could result in the formation of a hematoma or a blood clot.

Experiencing nerve injury at the injection location.

You will temporarily lose control of your bladder and intestines. To pee, you may require a catheter (a tiny tube) in your bladder.

Receiving ESI injections too frequently or taking greater dosages of steroid medicine may weaken your spine’s bones or adjacent muscles. As a result, most healthcare providers limit consumers to two to three ESIs per year.

While complications from an epidural steroid injection are extremely rare, they can have long-term repercussions, including:

 

Persistent neurologic disability as a result of epidural injection-caused spinal cord or nerve root damage.

Persistent pain as a result of spinal cord or nerve root injury caused by the epidural injection.

A hematoma causes permanent paralysis when blood accumulates between the dura mater and the spinal cord.

Since each person is different and there are many possible reasons for chronic pain that an ESI could help with, the results of an ESI can vary. About half of the people who get an ESI feel better afterward.

Even though there is evidence that epidural steroid injections work to relieve pain, the length of time the pain relief lasts may vary. This depends a lot on what’s causing the pain in the first place. The pain relief might last for weeks or months, but it doesn’t usually last for a whole year.

 

You can get more than one ESI over time, but most doctors only give two to three ESIs per year. Most of the time, ESIs don’t get rid of the cause of your pain. People with chronic pain who get ESIs often need other types of therapy to keep the pain from coming back.

 

When should I see a doctor or nurse?

If you have any of the following symptoms after your ESI injection, call your doctor or go to the hospital as soon as possible:

 

  • When you’re standing or sitting, you get a bad headache that goes away when you lie down. This might be a sign of a hole in the dura.
  • Having a fever, which could mean you have an infection.
  • Having less or no control over your bladder or bowels.
  • If you feel numbness and/or weakness in your legs, it could be a sign that a nerve has been damaged.