Epidural Steroid Injection

Overview

Epidural steroid injection is a minimally invasive procedure that delivers corticosteroid medication into the epidural space surrounding the spinal nerves. The procedure aims to reduce inflammation and provide pain relief for conditions such as herniated discs, spinal stenosis, or radiculopathy. Relief may be temporary or prolonged, and injections are often used as part of a comprehensive treatment plan.

Indications

This procedure may be considered when:

• •Lumbar radiculopathy (sciatica) from disc herniation or stenosis
• •Cervical radiculopathy causing arm pain
• •Spinal stenosis with neurogenic claudication or radicular symptoms
• •Degenerative disc disease with inflammatory component
• •Post-surgical pain syndrome in some cases
• •As a diagnostic tool to help identify the source of pain
• •Bridge therapy while awaiting surgery or pursuing conservative treatment

How It Works

The procedure typically involves several coordinated steps:

• •The procedure is typically performed in an outpatient setting
• •The patient is positioned prone or on their side depending on the approach
• •The skin is cleaned and local anesthetic is used to numb the injection site
• •Fluoroscopy (live X-ray) or ultrasound guidance is used to visualize needle placement
• •A needle is advanced into the epidural space using one of several approaches (interlaminar, transforaminal, or caudal)
• •Contrast dye may be injected to confirm correct needle placement
• •A mixture of corticosteroid and often local anesthetic is injected
• •The corticosteroid works to reduce inflammation around the irritated nerves
• •The procedure typically takes 15 to 30 minutes

Risks

As with any surgical procedure, potential risks include:

• •Temporary increase in pain or discomfort
• •Infection (rare but can be serious if it occurs)
• •Bleeding or hematoma, especially in patients on blood thinners
• •Nerve damage (rare)
• •Dural puncture causing spinal headache
• •Allergic reaction to medication or contrast
• •Systemic effects of steroids such as elevated blood sugar, fluid retention, or mood changes
• •Rare serious complications including epidural abscess or spinal cord injury
• •Limited evidence of effectiveness for some conditions

Recovery Expectations

Recovery follows a gradual progression:

• •The procedure is typically done on an outpatient basis with same-day discharge
• •Some patients may experience temporary numbness or weakness from local anesthetic
• •Driving is usually not recommended immediately after the procedure
• •Most patients can resume normal activities within 24 hours
• •Pain relief may begin within days, though maximum effect may require 1 to 2 weeks
• •Duration of relief varies widely among individuals, from weeks to months
• •A series of injections may be recommended, typically limited to 3 to 4 per year
• •Injections are often combined with physical therapy and other treatments

Alternatives

Depending on individual circumstances, alternatives may include:

• •Oral medications including NSAIDs, muscle relaxants, or oral steroids
• •Physical therapy and exercise programs
• •Activity modification and ergonomic changes
• •Selective nerve root blocks for more targeted treatment
• •Facet joint injections if facet joints are the pain source
• •Surgical decompression for appropriate candidates
• •Spinal cord stimulation for chronic refractory pain
• •Integrative approaches including acupuncture or chiropractic care

Sources

• Mayo Clinic – Epidural Steroid Injection
• Cleveland Clinic – Epidural Steroid Injection