Epidural Steroid Injections for Spine Pain

Epidural steroid injection is a procedure where a corticosteroid medication is injected into the spinal canal. It is most often performed to treat conditions which result in pain, numbness or tingling in an arm or leg due to nerve compression in the spine. The medical term for this condition is “radiculopathy”, but it is more commonly known as “sciatica” when the symptoms involve the leg. Examples of conditions which can cause such symptoms include, but are not limited to, herniated discs in the cervical (neck) or lumbar (low back) spine, spinal stenosis (narrowing of the spine canal, and spondylolisthesis (misalignment between two vertebrae). Read on for more about how epidural steroid injections can help with spine pain.

Although commonly performed, an epidural steroid injection is not typically the first option when treating symptoms that are due to nerve compression in the spine. More often, after a careful history and physical exam are performed, more conservative options such as activity modification, anti-inflammatories, ergonomic corrections and physical therapy are recommended. If there is not adequate improvement with this approach, MRI examination of the spine is usually performed. A MRI provides a detailed image of the bones and soft tissues in the spine which helps confirm the specific level in the spine causing the problem. If the MRI results, physical exam findings and patient symptoms are all consistent, then epidural steroid injection is often considered.

An epidural steroid injection is performed with the assistance of a special type of X-ray called fluoroscopy, which is a “live” X-ray. The use of fluoroscopy is an important tool when performing epidural steroid injections. Research has shown that without fluoroscopic guidance epidural steroid injections can be misplaced 30% of the time.

When an epidural steroid injection is performed, local anesthetic is used to numb the skin and soft tissues to minimize discomfort during the procedure. A doctor will insert a thin needle through the anesthetized area and use the fluoroscope to get the correct needle placement, as determined by the previous MRI scan. Once correct placement has been confirmed, the cortisone/steroid medication is injected. This is followed by a short period of observation after the procedure before being discharged home. The benefits of the injection are usually noticed within 2-3 days of receiving the injection and improvement may continue over the next 7 days. The benefit could last for weeks to several months or longer as the response to injection is highly variable. In some instances the epidural injection is not helpful. This wide range of responses is also reflected in the results of the many studies which attempted to evaluate the efficacy of epidural steroid injections.

Most physicians who perform epidural injections will recommend no more than 3 injections within 12 months; however, there is not a clear consensus regarding this in the medical literature. An epidural steroid injection is generally viewed as a safe procedure. Potential risks associated with the procedure include, but are not limited to, infection, bleeding, nerve damage and dural puncture, which can result in a severe headache. Possible transient side effects related to the steroid medication include headache; restlessness; anxiety; flushing or redness in the face, neck and chest area; elevated blood sugar, particularly in those with diabetes; and increased pain. Epidural steroid injections should not be viewed as a “cure” for nerve pain, but rather a useful adjunct to the overall treatment plan. The steroid medication that is injected can bring about pain relief by diminishing the inflammation of the nerves that are being compressed in the spine. In turn, this allows for more effective participation in
a rehabilitation program, decreased need for oral medications and improved overall quality of life.

Interested in learning more about Sciatica? Resurgens covers the basics here.

Krystal W. Chambers, M.D., received her medical degree from Louisiana State University Medical Center in New Orleans, Louisiana. She completed her residency in Physical Medicine and Rehabilitation at The Graduate Hospital in Philadelphia, Pennsylvania and her fellowship in Selective Spinal Injections and Non-operative Spine Care at Georgia Pain Physicians, P.C., in Marietta, Georgia. Dr. Chambers is board certified in Physical Medicine and Rehabilitation. Additionally, she is a member of the American Academy of Physical Medicine and Rehabilitation and the Physiatric Association of Spine, Sports and Occupational Medicine. Dr. Chambers practices at the Resurgens St. Joseph’s/Sandy Springs location.