Epidural Steroid Injection

What is an epidural?
The use of spinal injections to treat pain was first documented in 1901. Today, epidural steroid injections have become an integral part of non-surgical management of neck and back pain. While the effects of the injection tend to be temporary, providing relief from pain for one week up to one year, it can provide sufficient pain relief to allow the patient to progress with their rehabilitation program and go about their usual daily activities.

An epidural is an injection that delivers steroid directly into the epidural space. Sometimes a flushing solution (either lidocaine or normal saline) is also used to help “flush out” inflammatory proteins from around the area that may be the source of pain. An epidural is effective in significantly reducing pain for approximately 50% of patients.

The epidural space is the space between the dura mater (a membrane) and the vertebral wall and is filled with fat and small blood vessels. It is located just outside of the dural sac. The dural sac surrounds the nerve roots and cerebrospinal fluid (the fluid that the nerve roots are bathed in). Steroids (corticosteroids) have been shown to reduce inflammation by inhibiting the production of substances that cause inflammation. The epidural injection can be highly effective because it delivers the medication directly to the site of the inflammation. The steroid usually takes 24 to 72 hours to decrease inflammation and start giving pain relief.

How is the injection performed?
An epidural steroid injection usually takes between 5-15 minutes. The patient lies flat on an x-ray table on their abdomen. Prior to the procedure, the skin is cleansed then numbed with lidocaine, which is similar to the novocaine that a dentist uses ( a “local” anesthetic).

Using fluoroscopy ( a live x-ray) for guidance, the physician directs a needle toward the epidural space. Fluoroscopy is considered important in guiding the needle into the epidural space, as controlled studies have found that medication is misplaced in 13% to 34% of epidural injections that are done without fluoroscopy.

Once the needle is in exact position, the steroid solution is injected. Following the injection, the patient is usually monitored for approximately 15 minutes before being discharged to go home. Patients are usually asked to rest on the day of injection. Normal activities may be typically resumed the following day.