Overview & Procedure
An epidural steroid injection (ESI) is a minimally invasive procedure that can help relieve neck, arm, back and leg pain caused by inflamed, irritated spinal nerves. ESIs may be performed to relieve pain caused by spinal stenosis, spondylolysis, or disc protrusion/herniation. Medications are administered to the irritated spinal nerves through the epidural space, the area just outside of the spinal cord, to decrease inflammation near the disc and spinal nerves. The effects of the ESI tend to be temporary. On average patients receive 3-6 months of relief. The goal is to reduce pain so you may resume normal activities and a physical therapy program. An epidural steroid injection includes both a long-lasting corticosteroid (i.e. triamcinolone, betamethasone), saline, and/or a local anesthetic numbing agent.
Fluoroscopy (Video X-ray) is used to improve safety and accuracy when guiding the needle into the epidural space. Patients can remain awake for the entire process and the ability to report any discomfort makes the procedure safer. Light sedatives can be given to lessen anxiety but need to be arranged before the day of the procedure. During the procedure, the patient will lie on their stomach on the fluoroscopy (Video X-ray) table. The back/neck will be prepped with a sterile solution and, using video X-ray the appropriate vertebrae level will be located. The doctor will numb the area with local anesthetic. The patient will then feel pressure as the needle is advanced into the epidural space. During and/or after the injection there may be a feeling of pressure in the back/neck and down the leg/arm. The needle is then removed, and a band-aid is placed over the site.
Immediately after the procedure, patients are sent to a separate room to recover. During this time, the patient’s vitals are monitored for any signs of an adverse reaction and the patient will be kept in the recovery room for a period of time. Most patients can walk around immediately after the procedure; however, some patients may experience temporary numbness or weakness. After being monitored for a short time, patients can usually leave and drive themselves home. If this is the patient’s first injection, or the doctor plans to use local anesthetic in the injection for diagnostic purposes, they must have someone else drive them home. If the area is sore apply ice to the back for 10-15 minutes every half hour for the remainder of the day. Patients should report any signs of a fever, infection, redness, swelling, and increased pain to their Southwest Spine and Pain Center physician immediately.