The spine can have many diseases that result in painful inflammation of nerves, ligaments, and discs. Disc herniations are commonly known to produce inflammation of the nerves due to irritation by noxious chemicals from the disc onto the nerve root, causing pain from the back to the hand or foot depending on the location of the disc herniation.
The epidural space is an area behind the spinal cord and spinal fluid that the nerves cross through in order to leave the spine. Epidural steroid injections may provide relief for this inflammation by calming inflammation and nerve irritation and swelling.
What is an Epidural Steroid?
This injection consists of corticosteroids (not the body builder steroids) that gradually dissolve where they are injected, coating the nerves and relieving some of the inflammation. Epidural steroids will not cure spinal stenosis, will not dissolve or reduce disc herniation size (only surgery or the body’s own enzymes can do this).They do provide moderate to excellent relief lasting usually 3-24 weeks or longer, and allow greater function while the body is attempting to resorb the disc herniation. Spinal stenosis or pain from the discs themselves will not gradually improve over time as is possible with disc herniation, therefore more frequent injections may be needed. There are three ways your doctor may enter the epidural space of the low back as seen in the diagram above: the choice of which often depends on your particular condition. In the neck, the needles are placed from the back of the neck.
UNDER NO CIRCUMSTANCES SHOULD ANY PHYSICIAN EVER GIVE THESE INJECTIONS WITHOUT X-RAY GUIDANCE SINCE THIS IS NOT ONLY DANGEROUS BUT AT LEAST 50-60% OF THE TIME THE INJECTIONS ARE GIVEN IN THE WRONG PLACE!
Do the injections hurt?
When performed properly under x-ray guidance, the injections are not very uncomfortable. You will feel a little stinging when we numb your skin with local anesthestic but after that you will only normally feel a slight pressure.
Bleeding, infection, nerve injury, spinal cord injury, abscess or blood clots, paralysis, spinal fluid leak with headache, allergic reactions and failure to relieve pain are all risks. Discuss specific risks or concerns with your physician prior to the procedure.
Rarely, when sedation is required, you should eat or drink nothing after midnight, continue your normal medications with a sip of water, and you should have a driver transport you home.
- Activity: Resume normal activity today but report any weakness or numbness immediately.
- Diet: Resume normal diet
- Medications: Resume normal medications unless otherwise instructed.
- Dressing: You may have a small bandaid or bandaids placed over the injection site. They can be removed the next day
- Discomfort at the Injection Site: Apply ice wrapped in a cloth for short periods of time (20 minutes/hour) during the first 24 hours, then apply low to medium heat as needed
- Side Effects: Steroid side effects include elevation of your blood sugar for 1-3 weeks especially if you are diabetic. More frequent checks of the blood sugar are necessary for the first 3 weeks after an injection if you are a diabetic. Also steroids may cause increased blood pressure for a week and if you have hypertension or are being treated with medications for hypertension, you need to check your blood pressure more often during the first week. The medication doses for diabetes and high blood pressure may have to be adjusted by your primary care doctor if these are elevated during the first week or so after a steroid containing injection. Some patients experience facial or chest redness or have excessive energy during the first 24 hours after the injection. Other problems that may occur are increased heaviness or length of your periods if you are still menstruating for a month or so, or you may need to adjust your medications if you are bipolar and experience any mania after your injection.
If you develop fever of more than 101 degrees during the first few days after the injection, new weakness or numbness in the arms or legs, severe increase in pain in the back or neck, or loss of bowel or bladder control, notify our office immediately, or if it is after hours go to an Emergency Department or Urgent Care, and explain the procedure you have had and the symptoms.
Return to Normal Activities
You may experience some numbness in the skin over the back during the first several hours. Relief from the diagnostic injection may last up to 12 hours. Relief from a steroid injection will begin in 12-24 hours. You may have some numbness in the leg, arm, foot, or hand immediately after the injection. If this occurs hours after the injection, call your physician to report this.
Be extremely careful about walking or standing if this occurs as there is an increased risk of falling.
Sedation and Anesthetic Effects
- Do not operate a motor vehicle within the first 12 hours after the injection.
- If sedation was given, do not plan to make any important decisions such as signing legal or important papers and do not consume alcohol or sedatives within 24 hours after the injection