FAQs on Epidural Steroid Injections in Colorado

 

An epidural steroid injection (ESI) is used to relieve neck, arm, back, and leg pain associated with inflamed and compressed spinal nerves. ESI is often given a series of three, with procedures spaced 4-6 weeks apart.

What medications are used in the ESI?

The corticosteroid agents used include betamethasone, triamcinolone, methyl-prednisolone, dexamethasone, and Depo-Medrol. In addition, the pain management specialist may add an anesthetic, such as bupivacaine or lidocaine. The medicines are delivered to the spinal nerve(s) through the epidural space (area between the protective covering of the nerves and the vertebrae).

What is the purpose of an epidural steroid injection?

Corticosteroid injections reduce inflammation and are effective when delivered directly onto the painful nerves. The ESI does not make a herniated disc smaller, but it will flush away proteins that cause irritation and swelling. The pain relief from and ESI can last from 1-24 months, which varies from person-to-person.

What conditions are treated using ESI?

Radiating pain and radiculopathy can occur from many spinal conditions. The ESI relieves symptoms associated with:

  • Spinal stenosis – This is narrowing of the spinal canal that causes compression of nerve roots that branch off the spinal cord.
  • Degenerative disc disease – With age and wear-and-tear, the intervertebral discs loose water content and shape. This causes the vertebrae to shift and move, compression spinal nerve.
  • Spondylolysis – With a fracture or weakness between the upper and lower facets of a vertebra, the vertebra slips forward, which is known as spondylolisthesis. This causes nerve root compression, pain, and radicular symptoms.
  • Herniated disc – The gel-like material inside a disc can rupture through a weakened area in the tough outer layers/wall (called the annulus). The disc material causes irritation, swelling, and pain when it comes in contact with a spinal nerve.

Who is a candidate for an ESI?

Epidural steroid injections are helpful for patients with inflammatory, painful conditions. You should not have an ESI if you have bleeding problems, an active infection, are pregnant, or poorly controlled diabetes. ESIs are often used to determine if surgery will be beneficial for the pain related to a disc herniation.

How do I prepare for the epidural steroid injection?

The doctor will first meet with you to assess your condition, take a medical history, and perform a physical examination. The doctor may take additional imaging studies of your spine to evaluated the problem. If you are taking a blood thinning medication (Plavix, Fragmin, Lovenox, Coumadin, or aspirin), you should notify the doctor as these agents are to be held for several days.  Because a sedative is used during the ESI procedure, arrange to have someone drive you home.

What happens during the ESI procedure?

When you arrive for your procedure, you will sign forms, change into a gown, and the nurse places an IV catheter in your hand. The nurse positions you face-down on the procedure bed, and cleans your back region using an antiseptic solution. The doctor then numbs the skin using a tiny needle and anesthetic. A low dose sedative is given, such as Versed or Valium. The procedure needle and catheter is inserted into the epidural space using a special type of x-ray called fluoroscopy. This allows the doctor to watch the needle on a monitor to ensure correct placement and delivery of the medication onto the inflamed nerve root.

What happens after the ESI?

You will remain in a recovery area for 60 minutes. Some patients report immediate relief of pain, especially when an anesthetic is used in the injection. Your back will feel a bit sore, but this resolves in a few days. We recommend you rest for 1-2 days, and gradually resume activities.

Does the epidural steroid injection work?

In a study involving patients with low back pain and a disc prolapse confirmed by MRI, doctors administered an injection of methyl prednisolone 80 mg with 2 ml of bupivacaine. In the study, the success rate was 85%, with no complications.

Resources

Jamadar NP, Ganesh K, Sandeep G, et al. (2013). Efficacy of Epidural Steroid Injections in Management of Chronic Low Back Pain. Ind Journ of Basic & Appl Med Res, 8(2), 903-911.

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