Epidural Steroid Injections

Not infrequently the nerve roots which leave the spinal canal in the low back region become inflamed and irritated through pressure exerted on them by the bones and tissues of the spine. Conditions which may cause this include injury, arthritis, bone spurs, spinal stenosis, and degenerative disc disease. Often the inflammation of these lumbar nerve roots and subsequent pain can be lessened and even eliminated by the injection of steroids, potent anti-inflammatory drugs, into the epidural space of the spinal canal . This epidural space in located between two layers of tissue covering the spinal cord. All lumbar nerve roots pass through this epidural space and are in a position to absorb directly medications placed into the space.

 

Prior to your first procedure, you will be scheduled for a complete consent and consultation time.  This usually takes about an hour and you are given all the information about side effects and possible complications.  You will also be asked to complete a significant pain questionaire that helps determine your specific treatment which helps you attain the best possible expected outcome and prognosis.  Following the consultation, you are under no obligation to complete the injection procedure.  If medically necessary, you may be scheduled to have blood work, X-rays/MRI, EKG, etc prior to being cleared medically for the anesthesia or injection procedure.

 

THE PROCEDURE:

 

As providers in Pain Management, we recommend that the epidural injection to be performed with the patient under concious sedation which is a light general anesthesia.   The patients also find this to significantly help reduce tension and pain and often has no memory of the procedure or the discomfort felt during the procedure.  Once under sedation, a Physician or CRNA, uses local anesthesia to desensitize an area in the low back at or near the level of the inflamed nerve(s). A blunt-tipped needle is then placed through the anesthetized area into the epidural space next to the nerve(s), and steroids are injected along with a saline solution. The desired result is a decrease in the inflammation of the affected nerves with, hopefully, substantial pain relief. The procedure takes approximately thirty to sixty minutes. In most cases there is very little discomfort experienced as the needle is positioned in the epidural space; however, there is a pressure sensation as the needle is placed into the back and often patients experience transient pain similar to their regular nerve root symptoms as the steroid solution is injected into the epidural space. Although this sensation may be uncomfortable, the reproduction is another means to monitor proper needle placement.

 

THE OBJECTIVE:

The benefit of epidural steroid injection is the potential for the lessening or elimination of lumbar nerve root pain. Over half the patients who have an epidural steroid injection report 50% to 70% pain relief. Some patients experience 100% relief . However, unfortunately, some patients have no relief at all. The pain relief can last for an undetermined amount of time. Some patients never have pain again, while some have a recurrence days to weeks following their injection. Both the quantity and quality of the pain relief, as well as the duration, are unpredictable. Epidural steroid injection is, however, a reasonable treatment option when conventional therapy such as analgesics, muscle relaxants, bed rest, lumbar exercises, chiropractic and/or physical therapy have failed to give relief and when one would like to avoid surgery, if possible.  We commonly use the epidural steroid injection as a pre-treatment to the Manipulation Under Anesthesia (MUA) program which helps restore the normal function to the area being treated.  The steroid reduces adhesions and inflammation and the MUA restores the function.  We have awesome results from this combination approach.  See Manipulation Under Anesthesia for more information on this treatment option.  This treatment program is our special and you can't get it at any of the local hospitals anywhere.  The hospitals are a little behind the times and there is always the hospital politics that interferes with giving progressive and innovative procedures.

 

POTENTIAL PROBLEMS:

As with any medical procedure, epidural steroid injections do have the potential for side effects or complications. The most common (occurring about 2% of the time) is spinal tap, which may result in the postponement of the procedure, plus the possibility of headache for the patient. The headache acquired with a spinal tap may range from mild to incapacitating. The primary treatment for this type of headache is bed rest and analgesics. If the headache is severe and persists two or three days, another procedure can be performed, usually eliminating most headaches very rapidly. The more serious, but very rare complications include: temporary or permanent nerve paralysis caused by hitting the nerve with the needle, introducing an infection into the epidural space, or some bleeding which could compromise a lumbar nerve. Serious complications such as these are extremely rare. The reported incidence is about 1 out of 6,000 and are usually associated with difficult post-surgical or severe cases.

It is recommended that you do not eat or drink anything for at least six hours prior to your injections. However, medications should be taken as usually prescribed with small sips of water. You must be either knowledgeable about your current medications and allergies, or bring a list of them with you.  There are certain medications, such as NSAIDS or blood thinner medications that require special monitoring and or may be discontinued prior to the injection.  This will be discussed with your doctor before scheduling or performing any injection procedure.

 

AFTER THE INJECTION:

You will be required to have a ride home following the procedure. Most patients will be able to resume normal activities the day following their injection, but some patients may have increased nerve root pain following the injection. These patients are advised to rest in a comfortable position for a day or so. Continuation of prescribed analgesics remain appropriate as needed for post-injection pain.

Your referring physician remains your primary care provider. Questions about follow-up care, exercise, analgesics, treatment course, etc. should be addressed to Dr. Boer.  Questions specifically about your epidural steroid injection may be addressed you referring physician or to your anesthesiologist or CRNA.

Follow-up visits to your referring physician after your injection vary. At a minimum, you should call your referring physician ten to fourteen days following your epidural steroid injection to discuss with him your experience with your block. Usually your anesthesiologist will follow up with you by telephone approximately two weeks following your injection.

All of your physicians hope your lumbar root nerve root pain and disability will resolve without surgery. Epidural steroid injection is one treatment option which may help you obtain this goal.