Epidural Steroid Injections
What are Epidural Steroid Injections
Vertebrae are the bones that form the spinal column. Nerves branch off the spinal cord and exit through the vertebrae. The covering over the nerve roots (the part of the nerve that exits the spinal canal) is called the dura. The space surrounding the dura is the epidural space.
Inflammation of the nerve roots may cause pain in your neck/arms or low back/legs. The nerve roots may become inflamed due to irritation from a damaged disc or from contact with bone spurs, among other things.
The term “epidural steroid injection” refers to the injection of corticosteroids into the epidural space to decrease inflammation of the nerve roots and thereby reducing the associated pain in the neck/arms or low back/legs. In many cases, it takes 3-7 days for the steroid to take effect reducing pain and improving function. Most patients will receive good relief for some weeks or up to three months after an injection, but only a small proportion obtain longer-lasting relief.
Additionally, it may provide permanent relief or provide a period of pain relief allowing other treatments like physical therapy to be more effective. Some patients do not experience any pain relief and may in fact suffer a temporary increase in pain and/or other symptoms.
Questions? If you have questions regarding the information you have read here, ask our staff for further information.
Make arrangements to have a responsible adult accompany and drive you home.
This is for your safety and the safety of others.
Before the Injection:
- If you are on blood thinners, please let Dr. Lutz and/or his staff that you are taking anticoagulants. Patients on Coumadin/Warfarin require a protime/INR blood test the day before the procedure. Bring these results with you to your appointment.
- Arrange for a driver as you will be restricted from driving for 4 hours following the procedure.
- Please do not eat or drink anything for two (2) hours before the procedure.
- Do not take any pain relievers six (6) hours prior to the procedure.
What to Expect:
The injection is performed by Dr. Lutz using sterile technique and fluoroscopy (a real-time X-ray process). You will be positioned on a table face down so that your vertebral spaces are as widely separated as possible. A small area will be prepared with an antiseptic solution before a needle is introduced and advanced into the epidural space of the spine. When the needle is in the epidural space, Dr. Lutz will inject the solution slowly and may ask you to describe what sensations you are feeling while the solution is being injected. Sensations of “pins and needles” in your arms or legs, headache or a sudden sharp pain should be reported.
If one injection does not provide complete relief, another injection may be prescribed 2-4 weeks later. However, you are unlikely to benefit from repeated injections if the first two (2) injections do not offer relief. If epidural steroid injections provide relief, only in exceptional cases would more than three (3) injections be recommended within a three (3) month period.
If pain becomes worse with an injection, repeating the procedure would be contraindicated.
Following the Procedure:
- No driving for 4 hours post procedure.
- Resume your normal diet.
- Resume your normal medications.
- Complete your pain analog sheet and fax to Dr. Lutz’s office (651) 313-8251.
- Limit your activity on the day of the procedure – no heavy lifting; gently test your range of motion.
- For pain at the injection site, a cold compress is recommended for 20-30 minutes at a time.
- You may shower after 24 hours. No tubs or pools for 48 hours.
- If a local anesthetic is used, you may experience some numbness, this should resolve within hours.
- If you are a diabetic, your blood sugars may be elevated for a few days following the injection.
- Note that it may take 3-7 days for the steroid to start relieving your pain.
- If you are still experiencing pain 2-3 weeks following the procedure, please call to schedule a follow-up appointment with Dr. Lutz.
- The most common side effect is a temporary increase in pain. This occurs in about 1% of epidural steroid injections.
- Headaches are another complication with an incidence of 1% and may be related to the nonintentional puncture of the innermost membrane which surrounds the spinal cord. In most cases, the headache subsides within a few hours.
- The steroid used in your injection may produce flushing of the face, a general feeling of restlessness and difficulty sleeping. This should improve within a few hours or days.
- Other rare, but documented side-effects of epidural steroid injections include: fluid retention, difficulty breathing, swelling of the face or other parts of the body, high blood pressure, irritation or damage to nerves of the lower or upper extremities, or pelvis. Please notify Dr. Lutz’s office if you experience any of these side effects.