Epidural Steroid Injections

Epidural steroid injections can be effective treatment for radicular pain and to improve function. Epidural steroid injections are often recommended for the treatment of the symptoms of degenerative disc disease, spinal stenosis, radicular pain, and radiculopathy.

Epidurals are a common treatment option for many kinds of back and leg pain. They may also be recommended to treat a compressed nerve in the cervical spine (the neck) that radiates pain, numbness and tingling down the arm.  Many people find substantial relief. Risks are rare. An epidural may also be used to diagnose the source of your pain.

An epidural spinal injection is not the same as epidural anesthesia given before childbirth which blocks pain signals to numb the lower body during labor and delivery.

Spinal anatomy

The spine is made of vertebrae. The spinal cord runs through the spinal canal surrounded by the vertebrae. It travels from the brain to the body and carries messages from the body to the brain, and from the brain to the body.  The dura mater is a protective membrane around the spinal cord.

Nerve roots branch off the spinal canal though facet joints, spaces on both sides of the vertebrae, and carry sensory and motor messages to and from the cervical, thoracic, and lumbar spine ending at the first or second lumbar vertebrae.

What is radicular pain?

Radicular pain occurs when there is damage to a nerve root that results in pain, burning, tingling, weakness, and numbness wherever the nerve root travels. Leg pain is a common problem related to the nerve root damage in the lumbar spine. Low back pain is also caused by nerve root compression. Sciatica is leg pain caused by compression of the sciatic nerve typically due to a herniated disc. 

What is radiculopathy?

Radiculopathy is a condition that occurs when an inflamed or compressed nerve causes problems with reflexes, weakness, and numbness. Many doctors use the terms radicular pain and radiculopathy interchangeably.

Radicular pain and radiculopathy can occur alone or together. It can be caused by many things, including herniated discs, bone spurs, spinal stenosis, and degenerative disc disease. Injections of steroids into the epidural space around the spinal cord can provide relief for radicular pain.

What is an epidural steroid injection and how does it work?

An epidural steroid injection is a minimally invasive procedure that can be used to treat radicular pain. An epidural involves injecting a numbing medication and a powerful anti-inflammatory steroid medication directly into the the space around the spinal cord called the epidural space. The steroid medication helps to reduce inflammation and swelling, which can help to relieve pain.

An epidural may be offered to patients who have failed conservative treatments for radicular pain and are not candidates for or choose not to have surgery.

What are the risks and side effects of an epidural steroid injection?

Epidurals are generally safe procedures with few risks and side effects. The most common side effect is temporary increase in pain that lasts less than 24 hours.  Other possible side effects include headaches, nausea, and fever. In rare cases, serious complications can occur, such as bleeding or infection. 

How is an epidural steroid injection performed?

Epidural steroid injections are typically performed in a hospital or outpatient clinic. The patient changes into a gown and lies face down on an x-ray table and the area to be treated is cleaned and sterilized.

Under fluoroscopic guidance, an imaging technique that uses x-rays to obtain real-time images of the spinal structure, your pain management specialist will insert a small needle into the epidural space, which is the space around the dura mater surrounding the spinal cord.

The goal is to place the needle as close to the nerve root that is causing the pain. Once in place, a small amount of steroid and local anesthetic are injected into the epidural space. The patient may feel some pressure as the medicine is injected. The hope is that this will help decrease inflammation around the nerve root and therefore decrease the pain. After the injection, you will wait in recovery for about 20 minutes to ensure you feel well and are ready to go home.

Epidural steroid injections offer short term relief which can last up to a year or more. Many interventional pain specialists will limit the number of epidurals a patient can have to three a year. The rational is that the steroid can cause bone loss and contribute to osteoporosis and facture risk.

At Ortho Illinois, we offer interventional pain management to diagnose and treat pain using minimally invasive procedures including epidural steroid injections. Contact us to discover the benefits of interventional pain management and schedule a consultation to learn how we can help you feel better without surgery or the need for medications.